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General NPI Number Information
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NPI Number | 1134106701
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Entity Type | Individual
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Provider Name | JORGE LUIS SANTIAGO COLON MD
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Gender | Male
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | RR 10 BOX 10078
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City | SAN JUAN
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State | PR
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Zip | 00926-9512
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Country | US
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Telephone | 787-539-2681
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Fax | 787-744-0180
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Provider Business Mailing Address
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Address Line | 4000 AVENUE SUITE 49, LAKE VIEW ESTATES
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City | CAGUAS
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State | PR
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Zip | 00725-3360
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Country | US
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Telephone | 787-539-2681
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Fax | 787-744-0180
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 12683
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License Number State | PR
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