Provider Demographics
NPI:1417653627
Name:COLON VEGA, CHRISTIAN CARLOS (MEDICAL STUDENT)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:CARLOS
Last Name:COLON VEGA
Suffix:
Gender:M
Credentials:MEDICAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. EL CORTIJO, STREET 2
Mailing Address - Street 2:A6
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-404-7584
Mailing Address - Fax:
Practice Address - Street 1:URB. EL CORTIJO, STREET 2
Practice Address - Street 2:A6
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-404-7584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program