Provider Demographics
NPI:1912375973
Name:COLLAZO, YALEIKA
Entity Type:Individual
Prefix:
First Name:YALEIKA
Middle Name:
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9627 VILLAS DE CIUDAD JARDIN
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-9805
Mailing Address - Country:US
Mailing Address - Phone:787-975-9705
Mailing Address - Fax:
Practice Address - Street 1:TRUJILLO MEDICAL
Practice Address - Street 2:CARR NUM 181 KM 2.1
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-5020
Practice Address - Country:US
Practice Address - Phone:787-975-9705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist