Provider Demographics
NPI:1508637000
Name:COLON SANTIAGO, BRYAN (MRC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:COLON SANTIAGO
Suffix:
Gender:M
Credentials:MRC
Other - Prefix:MR
Other - First Name:BRYAN
Other - Middle Name:
Other - Last Name:COLON SANTIAGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MRC
Mailing Address - Street 1:RR 2 BOX 7707
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9726
Mailing Address - Country:US
Mailing Address - Phone:787-210-7793
Mailing Address - Fax:
Practice Address - Street 1:CARR 844 CAMINO LOS PIZARRO
Practice Address - Street 2:K, 0.7 INT CUPEY WARD
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-210-7793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1636225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor