Healthcare Provider Details

I. General information

NPI: 1790895472
Provider Name (Legal Business Name): LUZ N COLON-DEMARTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUZ N COLON MATEO

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF PUERTO RICO MEDICAL SCIENCE CAMPUS DEPT OF PSYCHIATRY
SAN JUAN PR
00936-5067
US

IV. Provider business mailing address

PO BOX 365067 DEPARTMENT OF PSYCHIATRY UNIVERSITY OF PUERTO RICO MECI
SAN JUAN PR
00936-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-4047
  • Fax: 787-766-0940
Mailing address:
  • Phone: 787-765-4047
  • Fax: 787-766-0940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number07985
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: