Provider Demographics
NPI:1326300799
Name:COLLAZOS, PAOLA D (AOS)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:D
Last Name:COLLAZOS
Suffix:
Gender:F
Credentials:AOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 SANTANDER AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6720
Mailing Address - Country:US
Mailing Address - Phone:191-729-4577
Mailing Address - Fax:718-779-2070
Practice Address - Street 1:284 SANTANDER AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6720
Practice Address - Country:US
Practice Address - Phone:917-294-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
FLMA97136225700000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist