Provider Demographics
NPI:1063252278
Name:COLON, ISLEBIALYS
Entity type:Individual
Prefix:
First Name:ISLEBIALYS
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 CALLE DAGUAO APT 804
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-7858
Mailing Address - Country:US
Mailing Address - Phone:787-377-0041
Mailing Address - Fax:
Practice Address - Street 1:CONDOMINIO MONTECENTRO
Practice Address - Street 2:APARTMENT H201
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-377-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver