Provider Demographics
NPI:1639925472
Name:COLON-VAZQUEZ, KHARLA (MS)
Entity type:Individual
Prefix:
First Name:KHARLA
Middle Name:
Last Name:COLON-VAZQUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3830
Mailing Address - Country:US
Mailing Address - Phone:860-712-1351
Mailing Address - Fax:
Practice Address - Street 1:300 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4412
Practice Address - Country:US
Practice Address - Phone:203-200-4362
Practice Address - Fax:203-200-1362
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator