Provider Demographics
NPI:1063094795
Name:COLON, GISEL M (DR)
Entity type:Individual
Prefix:
First Name:GISEL
Middle Name:M
Last Name:COLON
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BARREADA COREA, CALLE GUSTAVO GUZMAN
Mailing Address - Street 2:B-5
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:939-644-8991
Mailing Address - Fax:
Practice Address - Street 1:BARREADA COREA, CALLE GUSTAVO GUZMAN
Practice Address - Street 2:B-5
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:939-644-8991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006755103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty