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General NPI Number Information
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NPI Number | 1316283039
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Entity Type | Individual
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Provider Name | JOSE COLON-COLLAZO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/27/2012
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Last Update Date | 12/27/2012
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Provider Practice Location Address
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Address Line | 20 CALLE FLORENCIO SANTIAGO
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City | COAMO
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State | PR
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Zip | 00769-3241
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Country | US
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Telephone | 787-717-0428
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2141
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City | COAMO
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State | PR
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Zip | 00769-4141
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Country | US
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Telephone | 787-717-0428
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 003206
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License Number State | PR
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