Provider Demographics
NPI:1083776082
Name:COLMENERO, ANA T
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:T
Last Name:COLMENERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 CALLE CRISANTEMO
Mailing Address - Street 2:SAN FRANCISCO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6311
Mailing Address - Country:US
Mailing Address - Phone:787-763-2334
Mailing Address - Fax:787-781-3391
Practice Address - Street 1:1324 AVE SAN ALFONSO
Practice Address - Street 2:ALTAMESA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3619
Practice Address - Country:US
Practice Address - Phone:787-793-1810
Practice Address - Fax:787-781-3391
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR040990OtherLCA
PR41255OtherSSS
PR9070101OtherHUMANA
PR5247OtherIMC