Healthcare Provider Details

I. General information

NPI: 1386600013
Provider Name (Legal Business Name): JORGE GABRIEL COLON VELEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 AVE. DE DIEGO SUITE 607
SAN JUAN PR
00907
US

IV. Provider business mailing address

PO BOX 365026
SAN JUAN PR
00936-5026
US

V. Phone/Fax

Practice location:
  • Phone: 787-722-9416
  • Fax: 787-723-7945
Mailing address:
  • Phone: 787-722-9416
  • Fax: 787-723-7945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number7797
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: