Provider Demographics
NPI:1235163502
Name:COLLAZO, ROSENDO (DO)
Entity Type:Individual
Prefix:
First Name:ROSENDO
Middle Name:
Last Name:COLLAZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33128-1616
Mailing Address - Country:US
Mailing Address - Phone:305-577-4840
Mailing Address - Fax:305-373-7431
Practice Address - Street 1:336 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-1616
Practice Address - Country:US
Practice Address - Phone:305-577-4840
Practice Address - Fax:305-373-7431
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 6345207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372675400Medicaid
FL372675400Medicaid
FL80784VMedicare PIN