Provider Demographics
NPI:1487095568
Name:COLON-TARBAL, CARMEN (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:COLON-TARBAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 AVE DOMENECH
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3501
Mailing Address - Country:US
Mailing Address - Phone:787-756-6651
Mailing Address - Fax:787-758-0286
Practice Address - Street 1:121 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3501
Practice Address - Country:US
Practice Address - Phone:787-756-6651
Practice Address - Fax:787-758-0286
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7906208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics