Healthcare Provider Details

I. General information

NPI: 1114663119
Provider Name (Legal Business Name): ADRIANA COLLAZO ORTIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 CALLE SANTA CRUZ
BAYAMON PR
00961-7052
US

IV. Provider business mailing address

PO BOX 191227
SAN JUAN PR
00919-1227
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax: 787-771-7928
Mailing address:
  • Phone: 787-758-2000
  • Fax: 787-771-7928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number024763
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: