Provider Demographics
NPI:1366613796
Name:COLLAZO CASTRO DERMATOLOGY CLINICS PSC
Entity type:Organization
Organization Name:COLLAZO CASTRO DERMATOLOGY CLINICS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-884-4400
Mailing Address - Street 1:SABANERA DORADO 91
Mailing Address - Street 2:CAMINO DE LOS COHITRES
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-884-4400
Mailing Address - Fax:787-884-8800
Practice Address - Street 1:C&C PROFESSIONAL BUILDING SUITE #4
Practice Address - Street 2:CARR. #2, URB.FLAMBOYAN, MARGINAL B-9
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-4400
Practice Address - Fax:787-884-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15836207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCY860AMedicare PIN