Provider Demographics
NPI:1184377814
Name:RIVERA COLLAZO, MELANIE (MD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:RIVERA 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:CALLE MARGARITA 195
Mailing Address - Street 2:LA SERRANIA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-644-9847
Mailing Address - Fax:
Practice Address - Street 1:AVE. PEDRO ALBIZU CAMPOS
Practice Address - Street 2:HOSPITAL MENONITA GUAYAMA
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15795I390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program