1053115287 NPI number — IVELISSE COLON GARCIA TRABAJADOR DE SALUD

Table of content: IVELISSE COLON GARCIA TRABAJADOR DE SALUD (NPI 1053115287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053115287 NPI number — IVELISSE COLON GARCIA TRABAJADOR DE SALUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLON GARCIA
Provider First Name:
IVELISSE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
TRABAJADOR DE SALUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLON GARCIA
Provider Other First Name:
IVELISSE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1053115287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 518
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOROVIS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00687-0518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-862-3000
Provider Business Mailing Address Fax Number:
787-862-2731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 518
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOROVIS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00687-0518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-862-3000
Provider Business Practice Location Address Fax Number:
787-862-2731
Provider Enumeration Date:
04/04/2025

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: 172V00000X , with the licence number:  104 , 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)





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