Individual provider Active NPI

Jorge A Montijo Colon, PH.D.

  • Clinical Neuropsychologist
  • San Juan, PR
National Provider Identifier
1720091218
Registry record updated Oct 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
211 Issued in PR
Practice address
623 Ave Ponce de Leon
1106
San Juan, PR 00917-4831
Phone
(787) 763-2660
Fax
(787) 763-2660
NPI assigned
Aug 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 27, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 211 PR Primary

Addresses

Primary practice location

623 Ave Ponce de Leon
1106
San Juan, PR 00917-4831

Mailing address

623 Ave Ponce de Leon
1106
San Juan, PR 00917-4831
Phone (787) 763-2660

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060315000551 PR Practitioner - Clinical Psychologist 5597772533 Practice locations: San Juan, PR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
211PRMDNaturopath
000211PRMDOccupational Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288137600000",
    "number": "1720091218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 AVE PONCE DE LEON",
            "address_2": "1106",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009174831",
            "telephone_number": "787-763-2660",
            "fax_number": "787-763-2660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 AVE PONCE DE LEON",
            "address_2": "1106",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009174831",
            "telephone_number": "787-763-2660",
            "fax_number": "787-763-2660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTIJO COLON",
        "first_name": "JORGE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2010-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "PR",
            "license": "211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.