Healthcare Provider Details

I. General information

NPI: 1447421219
Provider Name (Legal Business Name): COLLAZO FERNANDEZ RICHARDS MD'S PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE SUITE 405
HOLLYWOOD FL
33021-5424
US

IV. Provider business mailing address

1150 N 35TH AVE SUITE 405
HOLLYWOOD FL
33021-5424
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-9993
  • Fax: 954-961-0163
Mailing address:
  • Phone: 954-961-9993
  • Fax: 954-961-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: LOUIS MANUEL COLLAZO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 954-961-9993