Provider Demographics
NPI:1265059893
Name:DIAZ COLON, LORENA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:MICHELLE
Last Name:DIAZ COLON
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:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-0560
Mailing Address - Country:US
Mailing Address - Phone:787-552-8789
Mailing Address - Fax:787-879-3995
Practice Address - Street 1:175 CALLE SAN FELIPE
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4605
Practice Address - Country:US
Practice Address - Phone:787-879-3995
Practice Address - Fax:787-879-3995
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR022688208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice