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General NPI Number Information
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NPI Number | 1730382870
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Entity Type | Individual
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Provider Name | RAPHAEL ALEXIS COLON-HERNANDEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 550 CALLE ELMA CAPARRA HEIGHTS
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City | SAN JUAN
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State | PR
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Zip | 00920-4703
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Country | US
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Telephone | 504-810-3110
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Fax |
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Provider Business Mailing Address
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Address Line | 9231 N 29TH ST
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City | PHOENIX
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State | AZ
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Zip | 85028-4805
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Country | US
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Telephone | 504-810-3110
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 11479
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License Number State | PR
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