Healthcare Provider Details

I. General information

NPI: 1417065343
Provider Name (Legal Business Name): MRS. VIOLETA COLLAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 AVE LAS AMERICAS EDIF PORRATA PILA SUITE 200
PONCE PR
00731
US

IV. Provider business mailing address

PO BOX 10369
PONCE PR
00732-0369
US

V. Phone/Fax

Practice location:
  • Phone: 787-841-6808
  • Fax: 787-841-6808
Mailing address:
  • Phone: 787-841-6808
  • Fax: 787-841-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number066
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: