Healthcare Provider Details

I. General information

NPI: 1619917382
Provider Name (Legal Business Name): EDWIN ALICEA-COLON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 CALLE CESAR GONZALEZ
SAN JUAN PR
00918-3712
US

IV. Provider business mailing address

1353 OLGA ESPERANZA ST. URB. SAN MARTIN
SAN JUAN PR
00924-4449
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-5401
  • Fax:
Mailing address:
  • Phone: 787-641-7582
  • Fax: 787-641-9541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11791
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number11791
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number11791
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: