Provider Demographics
NPI:1255391074
Name:COLON COLMENERO, TAMARA I (MD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:I
Last Name:COLON COLMENERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAMARA
Other - Middle Name:I
Other - Last Name:COLON COLMENERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:430 ST. MR20
Mailing Address - Street 2:COUNTRY CLUB
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982
Mailing Address - Country:US
Mailing Address - Phone:787-409-2246
Mailing Address - Fax:
Practice Address - Street 1:1028 AVE FD ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2904
Practice Address - Country:US
Practice Address - Phone:787-781-8316
Practice Address - Fax:787-783-0432
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9596208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF07469Medicare UPIN