| Organization Name: | COLONIAL MEDICAL MANAGEMENT, CORP |
| NPI Number: | 1164771853 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID ALICEA (MANAGER) |
| Mailing Address: | Carr 402 Km 1.8 Bo Marias Anasco |
| State: | PR US |
| Postal Code: | 00610 |
| Phone Number: | 7878268082 |
| Fax Number: | 7872291091 |
| NPI Enumeration Date: | 09/10/2012 |
| NPI Last Update Date: | 09/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0206X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology, Mammography |
| Taxonomy Definition: | |