Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 10695 | PR |
N | 208000000X | Pediatrician | 10695 | PR |
N | 208D00000X | General Practice Physician | 10695 | PR |
NPI | 1043296551 |
---|---|
Provider Name | Mrs. Cynthia Milagros Correa-Colon |
First Address | Amarillo, TX 79114-2322 |
Second Address | Amarillo, TX 79106-1990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 03/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
87788 | TRIPLE-S, INC. (01) | PR |