Provider Demographics
NPI:1295945053
Name:COLLAZO, JESUS ARTURO (RPH)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:ARTURO
Last Name:COLLAZO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:690 CALLE CESAR GONZALEZ
Mailing Address - Street 2:APT. 902
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3901
Mailing Address - Country:US
Mailing Address - Phone:787-484-5394
Mailing Address - Fax:787-282-8996
Practice Address - Street 1:690 CALLE CESAR GONZALEZ
Practice Address - Street 2:APT. 902
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3901
Practice Address - Country:US
Practice Address - Phone:787-484-5394
Practice Address - Fax:787-282-8996
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR45961835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support