Provider Demographics
NPI:1891901542
Name:COLON ORTIZ, EDNA S (MD)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:S
Last Name:COLON ORTIZ
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:CALLE 16,C-17,VILLA HUMACAO
Mailing Address - Street 2:P.O.BOX 554
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0554
Mailing Address - Country:US
Mailing Address - Phone:787-852-0129
Mailing Address - Fax:787-801-2900
Practice Address - Street 1:CALLE 16,C-17,VILLA HUMACAO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792-0554
Practice Address - Country:US
Practice Address - Phone:787-852-0129
Practice Address - Fax:787-801-2900
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR59642083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5964OtherSTATE LICENSE,PUERTO RICO
PRC-77563Medicare UPIN