Healthcare Provider Details

I. General information

NPI: 1760412142
Provider Name (Legal Business Name): FRANCISCO CARBALLO-COLLAZO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL MUNICIPAL DE SAN JUAN BARRIO MONACILLOS
SAN JUAN PR
00935
US

IV. Provider business mailing address

2056 CALLE TOPACIO BUCARE
GUAYNABO PR
00969-5135
US

V. Phone/Fax

Practice location:
  • Phone: 787-616-1658
  • Fax:
Mailing address:
  • Phone: 787-616-1658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2851
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: