Healthcare Provider Details

I. General information

NPI: 1972411627
Provider Name (Legal Business Name): LABORATORIO CLINICO COLLAZO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR 818 KM 0.3 PLAZA DIVINA UNIT 3
COROZAL PR
00783
US

IV. Provider business mailing address

PO BOX 213
COROZAL PR
00783-0213
US

V. Phone/Fax

Practice location:
  • Phone: 787-989-3138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: YESENIA COLLAZO
Title or Position: OWNER
Credential: MLS
Phone: 787-989-3138