Provider Demographics
NPI:1336793041
Name:COLON-RIVERA, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:COLON-RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CALLE M
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4975
Mailing Address - Country:US
Mailing Address - Phone:787-426-4776
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF SOUTH FLORIDA DEPARTMENT OF PSYCHIATRY
Practice Address - Street 2:3515 E FLETCHER AVE
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4706
Practice Address - Country:US
Practice Address - Phone:813-821-8032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLTRN311242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program