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NPI Code Detail

MEDICARE: MRS. LISA DOREEN COLON

MEDICARE: MRS. LISA DOREEN COLON
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1760522262
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA DOREEN COLON
Provider Business Mailing Address
First Line : 1220 WILLIS AVE
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32114-2810
Country : US
Telephone Number : 386-416-1023
Fax Number : 386-416-1037
Provider Business Practice Location Address
First Line : 311 N ORANGE ST
Second Line :
City : NEW SMYRNA BEACH
State : FL
Zip : 32168-6733
Country : US
Telephone Number : 386-416-1040
Fax Number : 386-416-1037
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2007
Last Update Date : 07/09/2007

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Directions to “ MRS. LISA DOREEN COLON ” Practice Location

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