Healthcare Provider Details

I. General information

NPI: 1326300799
Provider Name (Legal Business Name): PAOLA D COLLAZOS A.O.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 SANTANDER AVE
CORAL GABLES FL
33134-6720
US

IV. Provider business mailing address

284 SANTANDER AVE
CORAL GABLES FL
33134-6720
US

V. Phone/Fax

Practice location:
  • Phone: 917-294-5777
  • Fax:
Mailing address:
  • Phone: 191-729-4577
  • Fax: 718-779-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA97136
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: