Healthcare Provider Details

I. General information

NPI: 1912356809
Provider Name (Legal Business Name): HECTOR OMAR COLLAZO SANTIAGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PONCE BYP STE 407 DAMAS HOSPITAL
PONCE PR
00717-1318
US

IV. Provider business mailing address

323 CALLE CARPINTERO CAMINO DEL SUR
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-8686
  • Fax:
Mailing address:
  • Phone: 787-607-4516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number21447
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21447
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number21447
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: