MEDICARE: DR. CARMEN COLON-TARBAL M.D.

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
1	208000000X	Pediatrics Physician	7906	PR

General Provider Information

NPI Number	:	1487095568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMEN COLON-TARBAL M.D.

Provider Business Mailing Address
First Line	:	121 AVE DOMENECH
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3501
Country	:	US
Telephone Number	:	787-756-6651
Fax Number	:	787-758-0286

Provider Business Practice Location Address
First Line	:	121 AVE DOMENECH
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3501
Country	:	US
Telephone Number	:	787-756-6651
Fax Number	:	787-758-0286

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2013
Last Update Date	:	07/17/2013

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