Healthcare Provider Details

I. General information

NPI: 1972244507
Provider Name (Legal Business Name): COLLAZO MEDICAL SERVICE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. STARLIGHT CALLE PERSEO 3113
PONCE PR
00717
US

IV. Provider business mailing address

URB. STARLIGHT CALLE PERSEO 3113
PONCE PR
00717
US

V. Phone/Fax

Practice location:
  • Phone: 939-438-7943
  • Fax: 787-842-4328
Mailing address:
  • Phone: 939-438-7943
  • Fax: 787-842-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: RAMSY COLLAZO LUGO
Title or Position: PRESIDENT / EMT-P
Credential:
Phone: 939-452-4908