Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 15049 | PR |
Y | 207QA0505X | Family Doctor - Adult Medicine | 15049 | PR |
NPI | 1043439870 |
---|---|
Provider Name | Mr. Aristides Colon-Pena |
First Address | Guayama, PR 00785 |
Second Address | Cayey, PR 00736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 20/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I-21360 | (02) | PR |