Basic Information
| Provider Information | |||||||||
| NPI: | 1659366797 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLON-MENDEZ | ||||||||
| FirstName: | MANUEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | COLON | ||||||||
| OtherFirstName: | MANUEL | ||||||||
| OtherMiddleName: | J | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 833 STREET, LA VILLA GARDEN APTS. | ||||||||
| Address2: | # 929 W | ||||||||
| City: | GUAYNABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009719107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877317310 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | EAST HIGHWAY #18 | ||||||||
| Address2: | |||||||||
| City: | PINE RIDGE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577700000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058675131 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 08/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 8636 | PR | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD2009-0711 | NM | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.