Provider Demographics
NPI:1174063416
Name:COLON, TEODORO
Entity type:Individual
Prefix:
First Name:TEODORO
Middle Name:
Last Name:COLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 CALLE PROF AUGUSTO VAZQUEZ RODRIGUEZ
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909
Mailing Address - Country:US
Mailing Address - Phone:787-497-0800
Mailing Address - Fax:
Practice Address - Street 1:1503 CALLE PROF AUGUSTO VAZQUEZ RODRIGUEZ
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-497-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator