Provider Demographics
NPI:1962194944
Name:ALICEA-COLLAZO, JESSICA MARIE (MLS(ASCP))
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:ALICEA-COLLAZO
Suffix:
Gender:F
Credentials:MLS(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 FERRER Y FERRER
Mailing Address - Street 2:APT. 1106
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-410-6584
Mailing Address - Fax:
Practice Address - Street 1:1785 FERRER Y FERRER
Practice Address - Street 2:APT. 1106
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-410-6584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR007942246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist