Provider Demographics
NPI:1376827600
Name:COLLAZO, SERGIO
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:
Last Name:COLLAZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 AVE MUNOZ RIVERA
Mailing Address - Street 2:PMB 216
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0211
Mailing Address - Country:US
Mailing Address - Phone:787-635-3348
Mailing Address - Fax:
Practice Address - Street 1:1575 AVE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0211
Practice Address - Country:US
Practice Address - Phone:787-635-3348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic