=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619000643
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETHZAIDA COLON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 CALLE JUNCOS
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00727-4956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-745-9567
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 370997
-----------------------------------------------------
City | CAYEY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00737-0997
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 2689
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------