Provider Demographics
NPI:1174656847
Name:HORACIO COLON ESTEVA
Entity Type:Organization
Organization Name:HORACIO COLON ESTEVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACTURADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:NILSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-721-7776
Mailing Address - Street 1:1448 AVE FERNANDEZ JUNCOS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2655
Mailing Address - Country:US
Mailing Address - Phone:787-721-7776
Mailing Address - Fax:787-721-7810
Practice Address - Street 1:1448 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2655
Practice Address - Country:US
Practice Address - Phone:787-721-7776
Practice Address - Fax:787-721-7810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1558470187Medicare ID - Type UnspecifiedNPI