Provider Demographics
NPI:1891748364
Name:PILA COLLAZO, LOUDES (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUDES
Middle Name:
Last Name:PILA 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 1:8035 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1335
Mailing Address - Country:US
Mailing Address - Phone:305-227-7262
Mailing Address - Fax:305-227-7411
Practice Address - Street 1:11760 BIRD RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8100
Practice Address - Country:US
Practice Address - Phone:305-227-0088
Practice Address - Fax:305-227-7411
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060851204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370505600Medicaid
FL370505600Medicaid