=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487314951
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL ENID COLON-GONZALEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2021
-----------------------------------------------------
Last Update Date | 12/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 429 AVE BARBOSA
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00923-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-919-0270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | T23 CALLE MONTELLANO
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00969-5234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-421-3686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 006993
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------