MEDICARE: MARCOS COLLAZO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146L00000X	Paramedic	P35402	CA
2	146L00000X	Paramedic	047999	CO
3	146L00000X	Paramedic	168840	OH
4	146L00000X	Paramedic	EMTP 2118	HI
5	146L00000X	Paramedic	133421	ND

General Provider Information

NPI Number	:	1083084743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCOS COLLAZO

Provider Business Mailing Address
First Line	:	4259 23RD AVE W STE 200
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-1534
Country	:	US
Telephone Number	:	206-535-8002
Fax Number	:

Provider Business Practice Location Address
First Line	:	4259 23RD AVE W STE 200
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-1534
Country	:	US
Telephone Number	:	206-535-8002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	06/30/2016

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Directions to “ MARCOS COLLAZO ” Practice Location

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