Healthcare Provider Details

I. General information

NPI: 1063329811
Provider Name (Legal Business Name): STEPHANY COLLAZO OTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. CARLOS J. ANDALUE IL17, ROYAL PALM,
BAYAMON PR
00956
US

IV. Provider business mailing address

PO BOX 2282
VEGA BAJA PR
00694-2282
US

V. Phone/Fax

Practice location:
  • Phone: 939-425-6194
  • Fax:
Mailing address:
  • Phone: 939-223-9163
  • Fax: 939-223-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number7511
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: