Provider Demographics
NPI:1114056405
Name:COLON, YALIXA
Entity Type:Individual
Prefix:MISS
First Name:YALIXA
Middle Name:
Last Name:COLON
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:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:COMERIO
Mailing Address - State:PR
Mailing Address - Zip Code:00782-0250
Mailing Address - Country:US
Mailing Address - Phone:787-688-4186
Mailing Address - Fax:
Practice Address - Street 1:D32 CALLE MARGINAL
Practice Address - Street 2:EXTENCION FOREST HILLS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5555
Practice Address - Country:US
Practice Address - Phone:787-620-3602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4084183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician