Provider Demographics
NPI:1043069461
Name:COLON-RODRIGUEZ, PABLO J
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:J
Last Name:COLON-RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 15572
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-9671
Mailing Address - Country:US
Mailing Address - Phone:787-404-3639
Mailing Address - Fax:
Practice Address - Street 1:HC 2 BOX 15572
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-9671
Practice Address - Country:US
Practice Address - Phone:787-404-3639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2996390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program