Healthcare Provider Details

I. General information

NPI: 1053399931
Provider Name (Legal Business Name): HYDEE L COLLAZO SANTIAGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 CALLE MORSE HOSPITAL LAFAYETTE
ARROYO PR
00714-2350
US

IV. Provider business mailing address

PO BOX 691
PATILLAS PR
00723-0691
US

V. Phone/Fax

Practice location:
  • Phone: 787-864-3494
  • Fax: 787-864-3494
Mailing address:
  • Phone: 787-315-5957
  • Fax: 787-839-8900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number14339
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: