Provider Demographics
NPI:1609331198
Name:COLON-PEREIRA, CARLOS I
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:I
Last Name:COLON-PEREIRA
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 1:26 CALLE EL VIGIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-2987
Mailing Address - Country:US
Mailing Address - Phone:787-458-5360
Mailing Address - Fax:
Practice Address - Street 1:26 CALLE EL VIGIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-2987
Practice Address - Country:US
Practice Address - Phone:787-458-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1359101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty