Healthcare Provider Details

I. General information

NPI: 1598625493
Provider Name (Legal Business Name): ALAINA RAE COLLAZO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 3RD ST STE 2
LAGUNA BEACH CA
92651-2307
US

IV. Provider business mailing address

130 W EL PORTAL
SAN CLEMENTE CA
92672-4632
US

V. Phone/Fax

Practice location:
  • Phone: 949-309-7986
  • Fax:
Mailing address:
  • Phone: 949-498-9088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: