Provider Demographics
NPI:1821254459
Name:COLON GUERRA, GARDINE MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:GARDINE
Middle Name:MICHELLE
Last Name:COLON GUERRA
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 1:35 CALLE JUAN C BORBON
Mailing Address - Street 2:SUITE NUMBER 67-395
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5374
Mailing Address - Country:US
Mailing Address - Phone:787-662-6832
Mailing Address - Fax:
Practice Address - Street 1:35 CALLE JUAN C BORBON
Practice Address - Street 2:SUITE NUMBER 67-395
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5374
Practice Address - Country:US
Practice Address - Phone:787-662-6832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18291207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services