Provider Demographics
NPI:1336189950
Name:COLON-CANDELARIA, MAYRA MILAGROS (MD)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:MILAGROS
Last Name:COLON-CANDELARIA
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 1:188 CALLE TEBAS
Mailing Address - Street 2:OLYMPIC COURT
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9016
Mailing Address - Country:US
Mailing Address - Phone:787-641-7582
Mailing Address - Fax:787-641-4561
Practice Address - Street 1:188 CALLE TEBAS
Practice Address - Street 2:OLYMPIC COURT
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-9016
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:787-641-4561
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14102207R00000X, 207RI0200X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7180119OtherHUMANA
PR100943OtherCRUZ AZUL DE PUERTO RICO
PR23321 COOtherTRIPLE-SSS
PR0023321Medicare ID - Type UnspecifiedPROVIDER