Provider Demographics
NPI:1306422472
Name:COLON, LUZ MARIA (SA-C)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:MARIA
Last Name:COLON
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8084 CYPRESS AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6735
Mailing Address - Country:US
Mailing Address - Phone:347-799-5742
Mailing Address - Fax:
Practice Address - Street 1:8084 CYPRESS AVE APT 3
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6735
Practice Address - Country:US
Practice Address - Phone:347-799-5742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19-382246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant