MEDICARE: GRETCHEN COLLAZO MD

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	207Q00000X	Family Medicine Physician	12,296I	PR
2	207Q00000X	Family Medicine Physician	28,187R	PR
3	207Q00000X	Family Medicine Physician	28,413R	PR
4	207Q00000X	Family Medicine Physician	28,794R	PR
5	207QG0300X	Geriatric Medicine (Family Medicine) Physician	20585	PR
6	284300000X	Special Hospital	12,102I	PR

General Provider Information

NPI Number	:	1598917700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN COLLAZO MD

Provider Business Mailing Address
First Line	:	3 SECTOR CARRASQUILLO
Second Line	:	SECTOR MARCELINO CARRASQUILLO
City	:	LAS PIEDRAS
State	:	PR
Zip	:	00771
Country	:	US
Telephone Number	:	787-421-3783
Fax Number	:

Provider Business Practice Location Address
First Line	:	DEPARTAMENTO MEDICINA DE FAMILIA Y GERIATRIA
Second Line	:	CALL BOX 6021
City	:	CAROLINA
State	:	PR
Zip	:	00984-0215
Country	:	US
Telephone Number	:	787-776-4420
Fax Number	:	787-776-4421

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	05/09/2013

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Directions to “ GRETCHEN COLLAZO MD” Practice Location

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