Healthcare Provider Details

I. General information

NPI: 1275455040
Provider Name (Legal Business Name): ALEX EDGARDO MORALES COLLAZO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WELLESLEY ST STE 1
WESTON MA
02493-1571
US

IV. Provider business mailing address

2476 VALHALLA DR
TAVARES FL
32778-8560
US

V. Phone/Fax

Practice location:
  • Phone: 781-768-7000
  • Fax:
Mailing address:
  • Phone: 787-209-6764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberRN9476525
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: