Provider Demographics
NPI:1962594366
Name:COLON VILLAFANE, JOSE ANTONIO (M:D:)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:COLON VILLAFANE
Suffix:
Gender:M
Credentials:M:D:
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Other - Credentials:
Mailing Address - Street 1:STREET 438 KM0.1 DOMINGO RUIZ
Mailing Address - Street 2:HC-01 B0X 4829
Mailing Address - City:SABANA HOYOS
Mailing Address - State:PR
Mailing Address - Zip Code:00688-9714
Mailing Address - Country:US
Mailing Address - Phone:787-881-9271
Mailing Address - Fax:787-881-9271
Practice Address - Street 1:STREET 438 KM0.1 DOMINGO RUIZ
Practice Address - Street 2:HC-01 B0X 4829
Practice Address - City:SABANA HOYOS
Practice Address - State:PR
Practice Address - Zip Code:00688-9714
Practice Address - Country:US
Practice Address - Phone:787-881-9271
Practice Address - Fax:787-881-9271
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR12039208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG73221Medicare UPIN