Provider Demographics
NPI:1669508370
Name:COLON GORBEA, DIANA M (MD)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:M
Last Name:COLON GORBEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 CABO ALVERIO ST. URB LA MERCED
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-763-5286
Mailing Address - Fax:787-763-5293
Practice Address - Street 1:CABO ALVERIO 554 ST. URB LA MERCED
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-763-5286
Practice Address - Fax:787-763-5293
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8890207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD95208Medicare UPIN
PR81213Medicare PIN