Provider Demographics
NPI:1144226887
Name:COLON MALDONADO, JOSE OSVALDO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:OSVALDO
Last Name:COLON MALDONADO
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:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-0615
Mailing Address - Country:US
Mailing Address - Phone:787-414-9391
Mailing Address - Fax:
Practice Address - Street 1:90-80 LUIS MUNOZ RIVERA
Practice Address - Street 2:HOSPITAL MENONITA AGUAS BUENAS CDT
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-732-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14456208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHO171AOtherMEDICARE PTAN
PRHO171AOtherMEDICARE PTAN