Provider Demographics
NPI:1821216151
Name:KUILAN-COLLAZO, JUAN ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:KUILAN-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 1:2053 PEDRO ALBIZU AV.
Mailing Address - Street 2:SUITE 2 PMB 3223
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5950
Mailing Address - Country:US
Mailing Address - Phone:787-310-5985
Mailing Address - Fax:
Practice Address - Street 1:2053 PEDRO ALBIZU AV.
Practice Address - Street 2:SUITE 2 PMB 323
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5950
Practice Address - Country:US
Practice Address - Phone:787-310-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13960207P00000X, 207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine