Healthcare Provider Details

I. General information

NPI: 1508985458
Provider Name (Legal Business Name): JULIA I. COLON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 CALLE CANADA
SAN JUAN PR
00920-3860
US

IV. Provider business mailing address

CALLE 53 BLOQUE 65 CASA#20 VILLA CAROLINA
CAROLINA PR
00985
US

V. Phone/Fax

Practice location:
  • Phone: 787-793-1828
  • Fax:
Mailing address:
  • Phone: 787-257-8426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2046
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: