Provider Demographics
NPI:1992837215
Name:COLON, JOSE LUIS
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:COLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BARRIO PUEBLO NUEVO NUMERO 34
Mailing Address - Street 2:CALLE 100
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-983-7356
Mailing Address - Fax:
Practice Address - Street 1:X1 CALLE 17
Practice Address - Street 2:ROYAL TOWN
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4534
Practice Address - Country:US
Practice Address - Phone:787-620-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5374183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician