Provider Demographics
NPI:1295188191
Name:COLON GARCIA-MOLINER, CLARA M (MD)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:M
Last Name:COLON GARCIA-MOLINER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CLARA
Other - Middle Name:MARIA
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4717 SAINT ANTOINE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1423
Mailing Address - Country:US
Mailing Address - Phone:313-577-8900
Mailing Address - Fax:
Practice Address - Street 1:4717 SAINT ANTOINE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1423
Practice Address - Country:US
Practice Address - Phone:313-577-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301506389207W00000X
PR23114207W00000X, 207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301506389OtherBOARD OF MEDICINE, MICHIGAN
PR23114OtherPR MEDICAL LICENSE AND DISCIPLINE BOARD
MI4351044153OtherLICENSE
PR23114OtherPR MEDICAL LICENSE AND DISCIPLINE BOARD