MEDICARE: JUAN C COLLAZOS-RODRIGUEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME131002	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215199294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN C COLLAZOS-RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	4695 MANDERLY DR
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33449-7406
Country	:	US
Telephone Number	:	702-756-9994
Fax Number	:	561-484-5752

Provider Business Practice Location Address
First Line	:	1410 ROYAL PALM BEACH BLVD
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1608
Country	:	US
Telephone Number	:	561-777-5246
Fax Number	:	561-484-5752

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	05/02/2021

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