Provider Demographics
NPI:1881218980
Name:COLON COLON, ALBA G
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:G
Last Name:COLON COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CALLE GEORGETTI
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-3012
Mailing Address - Country:US
Mailing Address - Phone:787-869-7213
Mailing Address - Fax:787-869-7213
Practice Address - Street 1:130 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-3012
Practice Address - Country:US
Practice Address - Phone:787-869-7213
Practice Address - Fax:787-869-7213
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6471103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty