Provider Demographics
NPI:1356441810
Name:COLLAZO, BRUNILDA (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUNILDA
Middle Name:
Last Name: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:PO BOX 190071
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-0071
Mailing Address - Country:US
Mailing Address - Phone:787-354-6337
Mailing Address - Fax:787-641-4518
Practice Address - Street 1:CALLE FERNANDEZ #6
Practice Address - Street 2:MEDICAL BUILDING 4TO PISO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-0071
Practice Address - Country:US
Practice Address - Phone:787-998-0639
Practice Address - Fax:787-998-4516
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2852208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics