Provider Demographics
NPI:1730312018
Name:COLON, ROSA I (LIC)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:I
Last Name:COLON
Suffix:
Gender:F
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE. BOULEVARD #2507, LEVITTOWN
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-0000
Mailing Address - Country:US
Mailing Address - Phone:787-397-8498
Mailing Address - Fax:787-281-0870
Practice Address - Street 1:CALLE COSTA NORTE, CHALETS
Practice Address - Street 2:#30
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-397-8498
Practice Address - Fax:787-281-0870
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist