Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 18469 | PR |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 18469 | PR |
NPI | 1184985376 |
---|---|
Provider Name | Maribel Colon-Vega |
First Address | Morovis, PR 00687-8722 |
Second Address | Morovis, PR 00687-8722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2012 |
Last Update Date | 24/08/2017 |