Provider Demographics
NPI:1962134650
Name:COLON GONZALEZ, LUIS GABRIEL (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:GABRIEL
Last Name:COLON GONZALEZ
Suffix:
Gender:M
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:PO BOX 2251
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2251
Mailing Address - Country:US
Mailing Address - Phone:787-543-0111
Mailing Address - Fax:
Practice Address - Street 1:CENTRO MEDICO EPISCOPAL SAN LUCAS
Practice Address - Street 2:917 AVENIDA TITO CASTRO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733
Practice Address - Country:US
Practice Address - Phone:787-844-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty