Provider Demographics
NPI:1669518445
Name:MARISOL COLLAZO ORTIZ INC
Entity type:Organization
Organization Name:MARISOL COLLAZO ORTIZ INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD MT
Authorized Official - Phone:787-739-5525
Mailing Address - Street 1:12 CALLE BARCELO
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-3446
Mailing Address - Country:US
Mailing Address - Phone:787-739-5525
Mailing Address - Fax:787-739-2054
Practice Address - Street 1:12 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3446
Practice Address - Country:US
Practice Address - Phone:787-739-5525
Practice Address - Fax:787-739-2054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR807291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
15843OtherAMPR
20213OtherPREFERRED MEDICARE CHOICE
6390009OtherHUMANA HEALTH PLAN
6390009OtherHUMANA INSURANCE
51539OtherLACRUZ AZUL DE PUERTO RIC
LB00746OtherUIA
20463OtherAMERICAN HEALTH
6390009OtherHUMANA REFORMA
30778OtherTRIPLE S
0877OtherINTERNATIONAL MEDICAL CAR
400123OtherPREFERRED HEALTH UTI
400123OtherPREFERRED HEALTH UTI
30778OtherTRIPLE S