Provider Demographics
NPI:1871148403
Name:COLON, MARILISSA (MT ASCP)
Entity type:Individual
Prefix:
First Name:MARILISSA
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:MT ASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11119 CALLE CRISANTEMOS
Mailing Address - Street 2:HACIENDA CONCORDIA
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-223-3417
Mailing Address - Fax:
Practice Address - Street 1:11119 CALLE CRISANTEMOS
Practice Address - Street 2:HACIENDA CONCORDIA
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-3115
Practice Address - Country:US
Practice Address - Phone:787-223-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR211798246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist