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NPI Code Detail

MEDICARE: MR. CARLOS MANUEL SANTIAGO COLON PSYD

MEDICARE:  MR. CARLOS MANUEL SANTIAGO COLON  PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorFL
2103T00000XPsychologist

General Provider Information

NPI Number : 1417657461
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CARLOS MANUEL SANTIAGO COLON PSYD
Provider Business Mailing Address
First Line : 10244 E COLONIAL DR STE 110
Second Line :
City : ORLANDO
State : FL
Zip : 32817-4365
Country : US
Telephone Number : 407-202-9440
Fax Number : 407-601-6879
Provider Business Practice Location Address
First Line : 10244 E COLONIAL DR STE 110
Second Line :
City : ORLANDO
State : FL
Zip : 32817-4365
Country : US
Telephone Number : 407-202-9440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2023
Last Update Date : 03/10/2023

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Directions to “ MR. CARLOS MANUEL SANTIAGO COLON PSYD” Practice Location

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