Provider Demographics
NPI:1356904304
Name:COLON RIVERA, JOSE ALEJANDRO
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ALEJANDRO
Last Name:COLON RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 CALLE OKLAHOMA SAN GERARDO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3305
Mailing Address - Country:US
Mailing Address - Phone:787-662-3814
Mailing Address - Fax:
Practice Address - Street 1:331 CALLE OKLAHOMA SAN GERARDO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3305
Practice Address - Country:US
Practice Address - Phone:787-662-3814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program