Provider Demographics
NPI:1760734891
Name:COLLAZO, HECTOR (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:COLLAZO
Suffix:
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 1:2555 COLLINS AVE
Mailing Address - Street 2:SUITE 1402
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4723
Mailing Address - Country:US
Mailing Address - Phone:305-552-0109
Mailing Address - Fax:
Practice Address - Street 1:8420 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2045
Practice Address - Country:US
Practice Address - Phone:305-552-0109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-13
Last Update Date:2012-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine