Provider Demographics
NPI:1225427651
Name:COLLAZO GUTIERREZ, NAOMI (MD)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:COLLAZO GUTIERREZ
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 1:118 AVE CARLOS CHARDON
Mailing Address - Street 2:COND QUANTUM METROCENTER APT 150
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-0001
Mailing Address - Country:US
Mailing Address - Phone:787-621-4828
Mailing Address - Fax:
Practice Address - Street 1:MMC PROFESSIONAL PLAZA
Practice Address - Street 2:URB ATENAS CALLE HERNANDEZ CARRION
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-621-4828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
PR019330207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR19330OtherPR LICENSE