Healthcare Provider Details

I. General information

NPI: 1821216151
Provider Name (Legal Business Name): JUAN ANTONIO KUILAN-COLLAZO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053 PEDRO ALBIZU AV. SUITE 2 PMB 323
AGUADILLA PR
00603-5950
US

IV. Provider business mailing address

2053 PEDRO ALBIZU AV. SUITE 2 PMB 3223
AGUADILLA PR
00603-5950
US

V. Phone/Fax

Practice location:
  • Phone: 787-310-5985
  • Fax:
Mailing address:
  • Phone: 787-310-5985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number13960
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number13960
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: