Provider Demographics
NPI:1073334512
Name:COLON ORTIZ, CORALYS MARY (DC)
Entity type:Individual
Prefix:
First Name:CORALYS
Middle Name:MARY
Last Name:COLON ORTIZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CALLE MUNOZ RIVERA UNIT 134
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-1677
Mailing Address - Country:US
Mailing Address - Phone:787-636-9475
Mailing Address - Fax:
Practice Address - Street 1:ZONA INDUSTRIAL, 1 CALLE FOMENTO
Practice Address - Street 2:SUITE 5
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-221-5228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor