Healthcare Provider Details

I. General information

NPI: 1184643751
Provider Name (Legal Business Name): JENIFFER COLLAZO MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. APOLO COMERCIAL APOLO #9
GUAYNABO PR
00969
US

IV. Provider business mailing address

ST. 9 N-18 SANTA TERESITA
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-272-0745
  • Fax: 787-272-0746
Mailing address:
  • Phone: 787-780-6889
  • Fax: 787-272-0746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number004088
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: