Provider Demographics
NPI:1730382870
Name:COLON-HERNANDEZ, RAPHAEL ALEXIS (MD)
Entity type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:ALEXIS
Last Name:COLON-HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9231 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4805
Mailing Address - Country:US
Mailing Address - Phone:504-810-3110
Mailing Address - Fax:
Practice Address - Street 1:550 CALLE ELMA
Practice Address - Street 2:CAPARRA HEIGHTS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-4703
Practice Address - Country:US
Practice Address - Phone:504-810-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11479207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine