1114023645 NPI number — DR. ORLANDO J COLON-AVILES DDS

Table of content: DR. ORLANDO J COLON-AVILES DDS (NPI 1114023645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114023645 NPI number — DR. ORLANDO J COLON-AVILES DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLON-AVILES
Provider First Name:
ORLANDO
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114023645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1572
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOCA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00676-1572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-877-2500
Provider Business Mailing Address Fax Number:
787-877-2505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROAD 110 KM 12.4
Provider Second Line Business Practice Location Address:
2ND FLOOR COLON PLAZA BUILDING
Provider Business Practice Location Address City Name:
MOCA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-877-2500
Provider Business Practice Location Address Fax Number:
787-877-2505
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2139 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2139 . This is a "PLAN DE SERVICIOS DE SALU" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6843 . This is a "INTERNATIONAL MED CARD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 206799 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 26258 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 70356 . This is a "PREFERRED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 41986 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 041734 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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