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General NPI Number Information
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NPI Number | 1760522262
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Entity Type | Individual
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Provider Name | MRS. LISA DOREEN COLON
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Gender | Female
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 311 N ORANGE ST
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-6733
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Country | US
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Telephone | 386-416-1040
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Fax | 386-416-1037
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Provider Business Mailing Address
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Address Line | 1220 WILLIS AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2810
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Country | US
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Telephone | 386-416-1023
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Fax | 386-416-1037
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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