Provider Demographics
NPI:1851689111
Name:PALOMO COLON, GINNELL MARIE (MED)
Entity Type:Individual
Prefix:MRS
First Name:GINNELL
Middle Name:MARIE
Last Name:PALOMO COLON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CALLE RUISENOR
Mailing Address - Street 2:HACIENDA LAS VEGAS
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-7000
Mailing Address - Country:US
Mailing Address - Phone:787-677-2331
Mailing Address - Fax:
Practice Address - Street 1:CALLE DEL PARQUE, COTO LAUREL
Practice Address - Street 2:BLOQUE 1 SUITE 2
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-358-7948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3616103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool