Healthcare Provider Details

I. General information

NPI: 1922419027
Provider Name (Legal Business Name): BELINDA A.L. COLLIAS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 MADISON AVE W
IMMOKALEE FL
34142-2200
US

IV. Provider business mailing address

874 TANBARK DR APT 202
NAPLES FL
34108-7543
US

V. Phone/Fax

Practice location:
  • Phone: 239-658-3707
  • Fax:
Mailing address:
  • Phone: 901-896-5208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS15582
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS15582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: