Provider Demographics
NPI:1548860869
Name:COLON MATIAS, LISMARY (MS)
Entity type:Individual
Prefix:
First Name:LISMARY
Middle Name:
Last Name:COLON MATIAS
Suffix:
Gender:F
Credentials:MS
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 1102
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1102
Mailing Address - Country:US
Mailing Address - Phone:939-258-9989
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA PONCE DE LEON #1607
Practice Address - Street 2:COBIAN'S PLAZA BUILDING
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912
Practice Address - Country:US
Practice Address - Phone:939-258-9989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist