Healthcare Provider Details

I. General information

NPI: 1245400480
Provider Name (Legal Business Name): VIOLETA COLLAZO IRIZARRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE LAS AMERICAS 2431 EDIF A 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 Code332H00000X
TaxonomyEyewear Supplier
License Number066
License Number StatePR

VIII. Authorized Official

Name: MRS. VIOLETA COLLAZO
Title or Position: OPTICIAN
Credential:
Phone: 787-841-6808