Provider Demographics
NPI:1306880927
Name:ENCARNACION COLLAZO, ALICE M (MD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:M
Last Name:ENCARNACION COLLAZO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:702 CALLE ROOSEVELT
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3449
Mailing Address - Country:US
Mailing Address - Phone:787-484-6943
Mailing Address - Fax:787-724-0616
Practice Address - Street 1:349 AVENIDA FELISA RINCON DE GAUTIER
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6675
Practice Address - Country:US
Practice Address - Phone:787-999-0889
Practice Address - Fax:787-999-0891
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2012-10-01
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Provider Licenses
StateLicense IDTaxonomies
PR8446208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
81704Medicare ID - Type Unspecified