Provider Demographics
NPI:1023159027
Name:COLON-DUENO, JOSE L (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:COLON-DUENO
Suffix:
Gender:M
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:PO BOX 195004
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5004
Mailing Address - Country:US
Mailing Address - Phone:787-748-1726
Mailing Address - Fax:787-748-1726
Practice Address - Street 1:12 CALLE HERADIO MENDOZA E
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-3801
Practice Address - Country:US
Practice Address - Phone:787-263-6464
Practice Address - Fax:787-263-6466
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7249174400000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE-30743Medicare UPIN
PR8-1749Medicare ID - Type Unspecified