Provider Demographics
NPI:1063415727
Name:COLON-MOLERO, ANGEL (MD, MBA)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:COLON-MOLERO
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11852 BATELLO LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7100
Mailing Address - Country:US
Mailing Address - Phone:305-968-0811
Mailing Address - Fax:
Practice Address - Street 1:5822 S SEMORAN BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-4812
Practice Address - Country:US
Practice Address - Phone:305-575-3419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD489579207R00000X
PR10725207R00000X
FLME168899207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDM 103093OtherSTATE DRUG LIC.
PRDM 103093OtherSTATE DRUG LIC.
PRDM 103093OtherSTATE DRUG LIC.