MEDICARE: MARENA COLLAZO-LUGO

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	225700000X	Massage Therapist	MA100417	FL

General Provider Information

NPI Number	:	1689411050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARENA COLLAZO-LUGO

Provider Business Mailing Address
First Line	:	2619 COLLEGE ST APT 5
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3539
Country	:	US
Telephone Number	:	305-975-5454
Fax Number	:

Provider Business Practice Location Address
First Line	:	4237 SALISBURY RD
Second Line	:	BUILDING 1, SUITE 107
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216
Country	:	US
Telephone Number	:	305-975-5454
Fax Number	:

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

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	07/11/2024

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Directions to “ MARENA COLLAZO-LUGO ” Practice Location

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