Provider Demographics
NPI:1417422353
Name:COLLAZO MALAVE, GERARDO ISRAEL SR (MD)
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:ISRAEL
Last Name:COLLAZO MALAVE
Suffix:SR
Gender:M
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:B55 CALLE SANCHEZ
Mailing Address - Street 2:URB APONTE
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736
Mailing Address - Country:US
Mailing Address - Phone:787-243-5979
Mailing Address - Fax:
Practice Address - Street 1:RECINTO DE CIENCIAS MEDICAS UPR
Practice Address - Street 2:DEPARTAMENTO DE PSIQUIATRIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-243-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR350192084P0800X
390200000X
PR223942084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program