Provider Demographics
NPI:1134106701
Name:SANTIAGO COLON, JORGE LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:LUIS
Last Name:SANTIAGO COLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 AVENUE
Mailing Address - Street 2:SUITE 49, LAKE VIEW ESTATES
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3360
Mailing Address - Country:US
Mailing Address - Phone:787-539-2681
Mailing Address - Fax:787-744-0180
Practice Address - Street 1:RR 10 BOX 10078
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9512
Practice Address - Country:US
Practice Address - Phone:787-539-2681
Practice Address - Fax:787-744-0180
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR126832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR222116Medicare UPIN
PR0090154Medicare ID - Type Unspecified
PR148088Medicare UPIN
90154SAMedicare UPIN