Healthcare Provider Details

I. General information

NPI: 1376686782
Provider Name (Legal Business Name): ERNESTO L COLLAZO BATISTA MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 CALLE PROF AUGUSTO RODRIGUE SEGUNDO PISO
SANTURCE PR
00909-2275
US

IV. Provider business mailing address

PO BOX 366407
SAN JUAN PR
00936-6407
US

V. Phone/Fax

Practice location:
  • Phone: 787-728-3700
  • Fax: 787-728-4390
Mailing address:
  • Phone: 787-728-3700
  • Fax: 787-728-4390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. ERNESTO LUIS COLLAZO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-728-3700