Jose Manuel Colon Gaztambide Sr., MD
Individual provider Active NPI General Practice Physician · Juana Diaz, PR
NPI 1285776500 · NPPES record last updated Feb 28, 2013
Key facts
- NPI
- 1285776500
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 8769 (PR)
- Practice address
- Comercio Street #106
Comercio Street #106
Juana Diaz, PR 00795 - Phone
- (797) 837-8912
- Fax
- (787) 260-3512
- NPI assigned
- Feb 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100903000962 | PR | Practitioner - General Practice | 9739203282 | Practice locations: Juana Diaz, PR |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8769 | PR | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 8769 | PR | Yes |
Addresses
Primary practice location
Comercio Street #106
Comercio Street #106
Juana Diaz, PR 00795
Mailing address
Comercio Street #106
Comercio Street #106
Juana Diaz, PR 00795
Phone (797) 837-8912
Other providers in Juana Diaz, PR
- Aurelio Miguel Collado Pacheco
- Mayra Alejandra Collazo-Bartolomei
- Carmen E Collazo
- James Collazo
- Brenda Luz Colon Arzola
- Cristina Isabel Colon Negron
- Jesmarie Colon Rodriguez
- Marlyn Lynette Colon Toro
- Camille Marie Colon
- Erika Colon
All providers in Juana Diaz, PR · General Practice Physician in Puerto Rico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.