Provider Demographics
NPI:1396041505
Name:COLLAZO ROSARIO, JESSICA (DC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:COLLAZO ROSARIO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CALLE NUNEZ ROMEU E
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-3815
Mailing Address - Country:US
Mailing Address - Phone:787-431-9577
Mailing Address - Fax:
Practice Address - Street 1:CALLE NUNEZ ROMEU 105 ESTE
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737
Practice Address - Country:US
Practice Address - Phone:787-431-9577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor