Healthcare Provider Details

I. General information

NPI: 1750722732
Provider Name (Legal Business Name): MADELINE MARQUEZ COLLAZO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 GUILLERMO RIEFKHOL STREET
PATILLAS PR
00723-0000
US

IV. Provider business mailing address

URB. VALLES DE PATILLAS R-1
PATILLAS PR
00723-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-839-4320
  • Fax: 787-271-0004
Mailing address:
  • Phone: 787-312-0748
  • Fax: 787-271-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number4980
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: