Provider Demographics
NPI:1629540240
Name:COLON, ROSA V (TS)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:V
Last Name:COLON
Suffix:
Gender:M
Credentials:TS
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:VIVIANA
Other - Last Name:COLON PARRILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:URB SANTA CRUZ
Mailing Address - Street 2:B7 CALLE SANTA CRUZ
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6902
Mailing Address - Country:US
Mailing Address - Phone:787-780-9196
Mailing Address - Fax:787-625-6124
Practice Address - Street 1:URB SANTA CRUZ
Practice Address - Street 2:B7 CALLE SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6902
Practice Address - Country:US
Practice Address - Phone:787-780-9196
Practice Address - Fax:787-625-6124
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR95071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9507OtherJUNTA DE LICENCIAMIENTO