Provider Demographics
NPI:1225135346
Name:ARZOLA COLLAZO, FERNANDO JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:JOSE
Last Name:ARZOLA COLLAZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FERNANDO
Other - Middle Name:JOSE
Other - Last Name:ARZOLA COLLAZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:929 N SPRING GARDEN AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0900
Practice Address - Country:US
Practice Address - Phone:386-738-9144
Practice Address - Fax:877-245-1597
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN552208D00000X
PR14074208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016868600Medicaid