Provider Demographics
NPI:1306001284
Name:SOTO COLLAZO, ELIZANETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZANETTE
Middle Name:
Last Name:SOTO 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 1:2218 CALLE JILGUERO
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-2581
Mailing Address - Country:US
Mailing Address - Phone:787-585-7388
Mailing Address - Fax:
Practice Address - Street 1:B13 URB MONCLOVA
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-2214
Practice Address - Country:US
Practice Address - Phone:787-585-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR172372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry