Basic Information
| Provider Information | |||||||||
| NPI: | 1962134650 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLON GONZALEZ | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | GABRIEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2251 | ||||||||
| Address2: | |||||||||
| City: | GUAYAMA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007852251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875430111 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CENTRO MEDICO EPISCOPAL SAN LUCAS | ||||||||
| Address2: | 917 AVENIDA TITO CASTRO | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878442080 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2022 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | PR | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.