Provider Demographics
NPI:1487314951
Name:COLON-GONZALEZ, CAROL ENID
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ENID
Last Name:COLON-GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:T23 CALLE MONTELLANO
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5234
Mailing Address - Country:US
Mailing Address - Phone:787-421-3686
Mailing Address - Fax:
Practice Address - Street 1:429 AVE BARBOSA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-1524
Practice Address - Country:US
Practice Address - Phone:787-919-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist