Provider Demographics
NPI:1053115287
Name:COLON GARCIA, IVELISSE (TRABAJADOR DE SALUD)
Entity type:Individual
Prefix:
First Name:IVELISSE
Middle Name:
Last Name:COLON GARCIA
Suffix:
Gender:
Credentials:TRABAJADOR DE SALUD
Other - Prefix:
Other - First Name:IVELISSE
Other - Middle Name:
Other - Last Name:COLON GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-0518
Mailing Address - Country:US
Mailing Address - Phone:787-862-3000
Mailing Address - Fax:787-862-2731
Practice Address - Street 1:PO BOX 518
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-0518
Practice Address - Country:US
Practice Address - Phone:787-862-3000
Practice Address - Fax:787-862-2731
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR104172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty