Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1849 | PR |
NPI | 1063643609 |
---|---|
Provider Name | Mr. Antonio J. Colorado III |
First Address | San Juan, PR 00936-7221 |
Second Address | San Juan, PR 00918-3014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2009 |
Last Update Date | 30/07/2009 |