Healthcare Provider Details

I. General information

NPI: 1720091218
Provider Name (Legal Business Name): JORGE A MONTIJO COLON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 AVE PONCE DE LEON 1106
SAN JUAN PR
00917-4831
US

IV. Provider business mailing address

623 AVE PONCE DE LEON 1106
SAN JUAN PR
00917-4831
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-2660
  • Fax: 787-763-2660
Mailing address:
  • Phone: 787-763-2660
  • Fax: 787-763-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number211
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: