Provider Demographics
NPI:1306059431
Name:DR. JANSEN COLBERG OFTALMOLOGO CSP
Entity type:Organization
Organization Name:DR. JANSEN COLBERG OFTALMOLOGO CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-834-9745
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0909
Mailing Address - Country:US
Mailing Address - Phone:787-834-9745
Mailing Address - Fax:
Practice Address - Street 1:351 AVE HOSTOS
Practice Address - Street 2:SUITE 203
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1502
Practice Address - Country:US
Practice Address - Phone:787-834-9745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12870207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty