Healthcare Provider Details

I. General information

NPI: 1144939612
Provider Name (Legal Business Name): ADELIS MARIE COLON TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ADELIS MARIE COLON TORRES NURSE

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 MAYORAL APTS APT 30
VILLALBA PR
00766-3316
US

IV. Provider business mailing address

6000 MAYORAL APTS APT 30
VILLALBA PR
00766-3316
US

V. Phone/Fax

Practice location:
  • Phone: 939-254-9322
  • Fax:
Mailing address:
  • Phone: 939-254-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number91670
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: