1821058199 NPI number — DR. CARLOS COLON-GOMEZ MD

Table of content: DR. CARLOS COLON-GOMEZ MD (NPI 1821058199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821058199 NPI number — DR. CARLOS COLON-GOMEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLON-GOMEZ
Provider First Name:
CARLOS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1821058199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 AVE TITO CASTRO
Provider Second Line Business Mailing Address:
SUITE 102 PMB 365
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00716-2232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-843-3661
Provider Business Mailing Address Fax Number:
787-843-3691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIF PARRA 2225 PONCE BYPASS
Provider Second Line Business Practice Location Address:
SUITE 807-808
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-1322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-812-5811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2006

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: 207X00000X , with the licence number:  10176 , 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)