Healthcare Provider Details

I. General information

NPI: 1083771224
Provider Name (Legal Business Name): SILVIA COLLAZO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CESAR CHAVEZ AVE STE 3300
LOS ANGELES CA
90033
US

IV. Provider business mailing address

1021 SOUTH RESERVOIR ST
POMONA CA
91766
US

V. Phone/Fax

Practice location:
  • Phone: 323-264-4114
  • Fax: 323-264-4662
Mailing address:
  • Phone: 909-623-3066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7572
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number20A7572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: