Provider Demographics
NPI:1023009396
Name:COLLADO, AURELIO MIGUEL
Entity Type:Individual
Prefix:DR
First Name:AURELIO
Middle Name:MIGUEL
Last Name:COLLADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 PONTEVEDRA ST.
Mailing Address - Street 2:URB. ANAIDA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE MUNOZ RIVERA #66
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-260-0137
Practice Address - Fax:787-260-7849
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9303174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41899Medicare UPIN