Provider Demographics
NPI:1124514096
Name:COLON, HECTOR JAVIER
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:JAVIER
Last Name:COLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 IRON HORSE LN
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-6707
Mailing Address - Country:US
Mailing Address - Phone:407-501-1989
Mailing Address - Fax:
Practice Address - Street 1:197 IRON HORSE LN
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-6707
Practice Address - Country:US
Practice Address - Phone:407-501-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP18000044183343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)