Basic Information
| Provider Information | |||||||||
| NPI: | 1326560939 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLON OTERO | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | MARY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 184 CALLE GUADALUPE ANTIGUO HOSPITAL SAN LUCAS 1 | ||||||||
| Address2: | INSPIRA BEHAVIORAL CARE | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00733 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 184 CALLE GUADALUPE PISO 2 INSPIRA BEHAVIORAL CARE | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007304325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877094130 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2017 | ||||||||
| LastUpdateDate: | 07/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | 83232 | PR | Y | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.