Provider Demographics
NPI:1255457016
Name:COLON-VAZQUEZ, JACQUELINE MILAGROS (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:MILAGROS
Last Name:COLON-VAZQUEZ
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 1:586 CALLE GREENWOOD
Mailing Address - Street 2:SUMMIT HILLS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-4348
Mailing Address - Country:US
Mailing Address - Phone:787-792-3855
Mailing Address - Fax:
Practice Address - Street 1:URB CARIBE, SECTOR EL CINCO, PONCE DE LEON ST
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-282-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRBC2492065251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare