Provider Demographics
NPI:1699802017
Name:COLON-ROLON, LISSANDRA (MD)
Entity type:Individual
Prefix:
First Name:LISSANDRA
Middle Name:
Last Name:COLON-ROLON
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 1:37 CALLE VEREDA
Mailing Address - Street 2:MONTEVERDEREAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5984
Mailing Address - Country:US
Mailing Address - Phone:787-409-7614
Mailing Address - Fax:787-841-7165
Practice Address - Street 1:37 CALLE VEREDA
Practice Address - Street 2:MONTEVERDEREAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5984
Practice Address - Country:US
Practice Address - Phone:787-409-7614
Practice Address - Fax:787-841-7165
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14310207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine