Provider Demographics
NPI:1386862886
Name:COLON, DIANA LIZ (PT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LIZ
Last Name:COLON
Suffix:
Gender:F
Credentials:PT
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 1124
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-1124
Mailing Address - Country:US
Mailing Address - Phone:787-601-3591
Mailing Address - Fax:787-847-3336
Practice Address - Street 1:BO. MOGOTE
Practice Address - Street 2:CARR # 151 KM 8.0
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-847-0736
Practice Address - Fax:787-847-3336
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004567183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3745449OtherELECTORAL
PR4262475OtherDRIVERS LICENSE