Provider Demographics
NPI:1942900964
Name:BURGOS COLLAZO, AXEL JAVIER SR (LMT)
Entity Type:Individual
Prefix:MR
First Name:AXEL
Middle Name:JAVIER
Last Name:BURGOS COLLAZO
Suffix:SR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CALLE JUAN COLON LOPEZ
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-2319
Mailing Address - Country:US
Mailing Address - Phone:787-341-7263
Mailing Address - Fax:
Practice Address - Street 1:URB CONDADO MODERNO CALLE JAZMIN 115
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0072
Practice Address - Country:US
Practice Address - Phone:787-341-7263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR855225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist