Provider Demographics
NPI:1639119316
Name:COLON RODRIGUEZ, DIEGO J (M D)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:J
Last Name:COLON RODRIGUEZ
Suffix:
Gender:M
Credentials:M D
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 200
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0200
Mailing Address - Country:US
Mailing Address - Phone:787-256-4541
Mailing Address - Fax:787-256-7610
Practice Address - Street 1:LOCAL AA-8
Practice Address - Street 2:LOIZA VALLEY MALL
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-256-4541
Practice Address - Fax:787-256-7610
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13771208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH68434Medicare UPIN
PR20551Medicare ID - Type Unspecified