Provider Demographics
NPI:1982887931
Name:JAIME VILLA COLON, C.S.P.
Entity Type:Organization
Organization Name:JAIME VILLA COLON, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:R
Authorized Official - Last Name:VILLA COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-259-3391
Mailing Address - Street 1:2225 PONCE BY PASS
Mailing Address - Street 2:PARRA BUILDING SUITE 403
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1320
Mailing Address - Country:US
Mailing Address - Phone:787-259-3391
Mailing Address - Fax:787-259-8474
Practice Address - Street 1:2225 PONCE BY PASS
Practice Address - Street 2:PARRA BUILDING SUITE 403
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1320
Practice Address - Country:US
Practice Address - Phone:787-259-3391
Practice Address - Fax:787-259-8474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8852207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
89725OtherSSS
89725OtherSSS