Healthcare Provider Details

I. General information

NPI: 1356346019
Provider Name (Legal Business Name): JOSE RAMON COLON - LEON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE VICTORIA 1559 1-B
SANTURCE PR
00912
US

IV. Provider business mailing address

PO BOX 40987
SAN JUAN PR
00940-0987
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-7759
  • Fax: 787-724-7766
Mailing address:
  • Phone: 787-724-7759
  • Fax: 787-724-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6480
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: