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General NPI Number Information
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NPI Number | 1972712669
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Entity Type | Individual
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Provider Name | LUISA M COLLAZO M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 759 AVE AVELINO VICENTE
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City | SAN JUAN
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State | PR
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Zip | 00909-2615
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Country | US
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Telephone | 787-644-9629
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Fax |
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Provider Business Mailing Address
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Address Line | 602 AVE FERNANDEZ JUNCOS APT 803
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City | SAN JUAN
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State | PR
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Zip | 00907-3149
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Country | US
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Telephone | 787-447-2831
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1988
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License Number State | PR
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