Healthcare Provider Details

I. General information

NPI: 1295945053
Provider Name (Legal Business Name): JESUS ARTURO COLLAZO R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 CALLE CESAR GONZALEZ APT. 902
SAN JUAN PR
00918-3901
US

IV. Provider business mailing address

690 CALLE CESAR GONZALEZ APT. 902
SAN JUAN PR
00918-3901
US

V. Phone/Fax

Practice location:
  • Phone: 787-484-5394
  • Fax: 787-282-8996
Mailing address:
  • Phone: 787-484-5394
  • Fax: 787-282-8996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number4596
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: