Provider Demographics
NPI:1205827854
Name:COLLAZO, MARGARITA R (MD)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:R
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LORRAINE MEDICAL SUITE 202
Mailing Address - Street 2:1681 PASEO VILLA FLORES
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2951
Mailing Address - Country:US
Mailing Address - Phone:787-284-2221
Mailing Address - Fax:787-284-2015
Practice Address - Street 1:LORRAINE MEDICAL SUITE 202
Practice Address - Street 2:1681 PASEO VILLA FLORES
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2951
Practice Address - Country:US
Practice Address - Phone:787-284-2221
Practice Address - Fax:787-284-2015
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F51209Medicare UPIN
PR83264Medicare ID - Type Unspecified