Provider Demographics
NPI:1851590392
Name:GARCIA-COLLAZO, ANA G (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:G
Last Name:GARCIA-COLLAZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 MILLER AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944
Mailing Address - Country:US
Mailing Address - Phone:509-837-7551
Mailing Address - Fax:509-837-6341
Practice Address - Street 1:812 MILLER AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944
Practice Address - Country:US
Practice Address - Phone:509-837-7551
Practice Address - Fax:509-837-6341
Is Sole Proprietor?:No
Enumeration Date:2007-07-14
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11454208000000X
WAMD60182163208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics