Provider Demographics
NPI:1558025239
Name:ATILANO COLLAZO, MAYRABETH
Entity Type:Individual
Prefix:
First Name:MAYRABETH
Middle Name:
Last Name:ATILANO 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:RR 4 BOX 5602
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-9057
Mailing Address - Country:US
Mailing Address - Phone:970-402-1284
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 405 KM 2.4
Practice Address - Street 2:BARRIO CARRERAS
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-9057
Practice Address - Country:US
Practice Address - Phone:970-402-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR091559163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse