Provider Demographics
NPI:1740656776
Name:COLLAZO-DIAZ, CYNTHIA YVETTE (MS SLP)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:YVETTE
Last Name:COLLAZO-DIAZ
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB PARQUE ECUESTRE
Mailing Address - Street 2:N4 C/PISAFLORES
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-0000
Mailing Address - Country:US
Mailing Address - Phone:787-635-9631
Mailing Address - Fax:
Practice Address - Street 1:71 CALLE AUTONOMIA
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3247
Practice Address - Country:US
Practice Address - Phone:787-402-5247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR628235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR628OtherSTATE LICENSE