MEDICARE: HEIDI J CUEVAS COLLAZO

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1225675085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI J CUEVAS COLLAZO

Provider Business Mailing Address
First Line	:	PO BOX 479
Second Line	:
City	:	GARROCHALES
State	:	PR
Zip	:	00652-0479
Country	:	US
Telephone Number	:	787-207-5341
Fax Number	:

Provider Business Practice Location Address
First Line	:	EDIF PROFESIONAL
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00927-5342
Country	:	US
Telephone Number	:	787-207-5341
Fax Number	:

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

Provider Enumeration Date	:	11/28/2019
Last Update Date	:	11/28/2019

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