Provider Demographics
NPI:1558475137
Name:COLON, JANINE S (GENERAL PRACTICE)
Entity Type:Individual
Prefix:DR
First Name:JANINE
Middle Name:S
Last Name:COLON
Suffix:
Gender:F
Credentials:GENERAL PRACTICE
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 441
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-0441
Mailing Address - Country:US
Mailing Address - Phone:787-626-3684
Mailing Address - Fax:787-626-3684
Practice Address - Street 1:111 CALLE JOSE C VAZQUEZ
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3301
Practice Address - Country:US
Practice Address - Phone:787-735-8787
Practice Address - Fax:787-735-8787
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13270174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH55633Medicare UPIN
PR90306Medicare ID - Type Unspecified