Provider Demographics
NPI:1417065343
Name:COLLAZO, VIOLETA
Entity Type:Individual
Prefix:MRS
First Name:VIOLETA
Middle Name:
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:
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 10369
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0369
Mailing Address - Country:US
Mailing Address - Phone:787-841-6808
Mailing Address - Fax:787-841-6808
Practice Address - Street 1:2431 AVE LAS AMERICAS EDIF PORRATA PILA SUITE 200
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-841-6808
Practice Address - Fax:787-841-6808
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR066156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0441010001Medicare PIN