1841257763 NPI number — DR. PEDRO NELSON COLBERG M.D.

Table of content: DR. PEDRO NELSON COLBERG M.D. (NPI 1841257763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841257763 NPI number — DR. PEDRO NELSON COLBERG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLBERG
Provider First Name:
PEDRO
Provider Middle Name:
NELSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1841257763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 SAN PATRICIO AVE
Provider Second Line Business Mailing Address:
MARAMAR PLAZA, SUITE 840
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-706-8341
Provider Business Mailing Address Fax Number:
787-706-5223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 AVE FD ROOSEVELT
Provider Second Line Business Practice Location Address:
SUITE 602
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918-8001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-250-8341
Provider Business Practice Location Address Fax Number:
787-765-1591
Provider Enumeration Date:
04/26/2006

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: 2084P0800X , with the licence number:  8258 , 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: 067909 . This is a "CRUZ AZUL PROVIDER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 81144 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 158896600 . This is a "OWCP PROVIDER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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