MEDICARE: PAOLA MICHELLE ROSARIO 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
1	1223P0221X	Pediatric Dentistry	3548	PR

General Provider Information

NPI Number	:	1962241703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAOLA MICHELLE ROSARIO COLON

Provider Business Mailing Address
First Line	:	210 CALLE JOSE OLIVER APT 906
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-2982
Country	:	US
Telephone Number	:	787-909-3306
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 CALLE JOSE OLIVER APT 906
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-2982
Country	:	US
Telephone Number	:	787-909-3306
Fax Number	:

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

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	07/16/2025

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