Healthcare Provider Details

I. General information

NPI: 1699707984
Provider Name (Legal Business Name): MARIA A COLLAZO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE JOSE DE DIEGO, CIALES PUEBLO NUM 25
CIALES PR
00638
US

IV. Provider business mailing address

E26 CALLE A SUR URB. FLAMBOYAN
MANATI PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-871-1146
  • Fax: 787-871-0625
Mailing address:
  • Phone: 787-871-1146
  • Fax: 787-871-0625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number40D07100418
License Number StatePR
# 8
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9227
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: