Provider Demographics
NPI:1215348321
Name:COLLAZO, RAFAEL JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:JOSE
Last Name:COLLAZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAFAEL
Other - Middle Name:JOSE
Other - Last Name:COLLAZO-DELGADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:420 CUMBRES DE MIRADERO
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-7518
Mailing Address - Country:US
Mailing Address - Phone:787-432-4331
Mailing Address - Fax:
Practice Address - Street 1:12 CALLE SOL
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine