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General NPI Number Information
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NPI Number | 1871148403
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Entity Type | Individual
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Provider Name | MARILISSA COLON MT ASCP
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Gender | Female
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Dates
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Enumeration Date | 08/09/2019
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 11119 CALLE CRISANTEMOS HACIENDA CONCORDIA
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City | SANTA ISABEL
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State | PR
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Zip | 00757-3115
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Country | US
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Telephone | 787-223-3417
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Fax |
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Provider Business Mailing Address
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Address Line | 11119 CALLE CRISANTEMOS HACIENDA CONCORDIA
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City | SANTA ISABEL
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State | PR
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Zip | 00757
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Country | US
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Telephone | 787-223-3417
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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 | 246QM0706X
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Taxonomy Name | Medical Technologist
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License Number | 211798
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License Number State | PR
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