Provider Demographics
NPI:1710589221
Name:COLON, JOSE LUIS JR
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:LUIS
Last Name:COLON
Suffix:JR
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 1:2022 PICADILLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-8632
Mailing Address - Country:US
Mailing Address - Phone:972-975-8418
Mailing Address - Fax:
Practice Address - Street 1:2022 PICADILLY BLVD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-8632
Practice Address - Country:US
Practice Address - Phone:972-975-8418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302560164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse