Provider Demographics
NPI:1548747553
Name:HERNANDEZ COLON, BRIAN JOSUE
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOSUE
Last Name:HERNANDEZ COLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CALLE SAN CARLOS
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982
Mailing Address - Country:US
Mailing Address - Phone:787-645-4257
Mailing Address - Fax:
Practice Address - Street 1:444 CALLE SAN CARLOS
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-3624
Practice Address - Country:US
Practice Address - Phone:787-645-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program