Basic Information
| Provider Information | |||||||||
| NPI: | 1912356809 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLAZO | ||||||||
| FirstName: | HECTOR | ||||||||
| MiddleName: | OMAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 323 CALLE CARPINTERO | ||||||||
| Address2: | CAMINO DEL SUR | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876074516 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2225 PONCE BYP STE 407 | ||||||||
| Address2: | DAMAS HOSPITAL | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007171318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878408686 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2016 | ||||||||
| LastUpdateDate: | 08/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 32282-R | PR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 21447 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.