MEDICARE: LUIS GABRIEL COLON FLORES MD

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	390200000X	Student in an Organized Health Care Education/Training Program		PR

General Provider Information

NPI Number	:	1962981076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS GABRIEL COLON FLORES MD

Provider Business Mailing Address
First Line	:	4705 CENTER BLVD APT 1904
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5692
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4705 CENTER BLVD APT 1904
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5692
Country	:	US
Telephone Number	:	787-692-6685
Fax Number	:

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

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	05/15/2025

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