Healthcare Provider Details

I. General information

NPI: 1285775387
Provider Name (Legal Business Name): CARMEN DAVILA-COLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PIES, PLANTA BAJA COLEGIO DE PROFESIONES RELACIONADAS CON LA SALUD
SAN JUAN PR
00927
US

IV. Provider business mailing address

PO BOX 365067
SAN JUAN PR
00936-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax: 787-764-1760
Mailing address:
  • Phone: 787-758-2525
  • Fax: 787-764-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number471
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: