Healthcare Provider Details

I. General information

NPI: 1942090436
Provider Name (Legal Business Name): LAURA MICHELLE COLLAZO ESTRADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 22 KM 2 BO MONACILLOS
SAN JUAN PR
00935-0001
US

IV. Provider business mailing address

S11 CALLE CERRO LA SANTA
CAROLINA PR
00987-8036
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-0333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1103-1
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: