MEDICARE: PAOLA D COLLAZOS A.O.S

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	222Q00000X	Developmental Therapist		FL
2	225700000X	Massage Therapist	MA97136	FL
3	171M00000X	Case Manager/Care Coordinator

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	:	1326300799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAOLA D COLLAZOS A.O.S

Provider Business Mailing Address
First Line	:	284 SANTANDER AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6720
Country	:	US
Telephone Number	:	191-729-4577
Fax Number	:	718-779-2070

Provider Business Practice Location Address
First Line	:	284 SANTANDER AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6720
Country	:	US
Telephone Number	:	917-294-5777
Fax Number	:

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

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	04/18/2022

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