Healthcare Provider Details

I. General information

NPI: 1760734891
Provider Name (Legal Business Name): HECTOR COLLAZO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2012
Last Update Date: 10/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 W FLAGLER ST
MIAMI FL
33144-2045
US

IV. Provider business mailing address

2555 COLLINS AVE SUITE 1402
MIAMI BEACH FL
33140-4723
US

V. Phone/Fax

Practice location:
  • Phone: 305-552-0109
  • Fax:
Mailing address:
  • Phone: 305-552-0109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: