Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 22154 | PR |
NPI | 1033513007 |
---|---|
Provider Name | Dr. Ivan Colon-Alvarado |
First Address | San Juan, PR 00926-6941 |
Second Address | San Juan, PR 00926-6941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2014 |
Last Update Date | 19/08/2021 |