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General NPI Number Information
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NPI Number | 1376686782
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Entity Type | Organization
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Legal Business Name | ERNESTO L COLLAZO BATISTA MD PSC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 1503 CALLE PROF AUGUSTO RODRIGUE SEGUNDO PISO
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City | SANTURCE
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State | PR
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Zip | 00909-2275
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Country | US
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Telephone | 787-728-3700
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Fax | 787-728-4390
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Provider Business Mailing Address
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Address Line | PO BOX 366407
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City | SAN JUAN
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State | PR
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Zip | 00936-6407
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Country | US
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Telephone | 787-728-3700
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Fax | 787-728-4390
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERNESTO LUIS COLLAZO
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Credential | M.D.
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Telephone | 787-728-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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