Provider Demographics
NPI:1245618065
Name:CANIZALES-COLLAZO, RODOLFO R (MD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:R
Last Name:CANIZALES-COLLAZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2648 LOOP 337
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132
Mailing Address - Country:US
Mailing Address - Phone:830-310-3203
Mailing Address - Fax:830-310-3204
Practice Address - Street 1:2648 LOOP 337
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132
Practice Address - Country:US
Practice Address - Phone:830-310-3203
Practice Address - Fax:830-310-3204
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS0643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine