Provider Demographics
NPI:1699707984
Name:COLLAZO, MARIA A (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:A
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:E26 CALLE A SUR
Mailing Address - Street 2:URB. FLAMBOYAN
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-871-1146
Mailing Address - Fax:787-871-0625
Practice Address - Street 1:CALLE JOSE DE DIEGO, CIALES PUEBLO
Practice Address - Street 2:NUM 25
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638
Practice Address - Country:US
Practice Address - Phone:787-871-1146
Practice Address - Fax:787-871-0625
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9227208D00000X
261QA1903X, 261QE0002X, 261QI0500X, 261QM1300X, 261QP2000X, 261QP3300X
PR40D07100418291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9227OtherMEDICAL LICENCE
PR0081187Medicare ID - Type UnspecifiedPROVIDER NUMBER
PR9227OtherMEDICAL LICENCE