Provider Demographics
NPI:1841566551
Name:SERGIO COLLAZO SR
Entity Type:Organization
Organization Name:SERGIO COLLAZO SR
Other - Org Name:SER-LADYS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-635-3348
Mailing Address - Street 1:2525 AVE EDUARDO RUBERTE
Mailing Address - Street 2:COLISEO SHOPPING CENTER SUITE 205
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1739
Mailing Address - Country:US
Mailing Address - Phone:787-635-3348
Mailing Address - Fax:
Practice Address - Street 1:2525 AVE EDUARDO RUBERTE
Practice Address - Street 2:COLISEO SHOPPING CENTER SUITE 205
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-1739
Practice Address - Country:US
Practice Address - Phone:787-635-3348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 6833416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport