Basic Information
| Provider Information | |||||||||
| NPI: | 1598881765 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLAZO | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | IVETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | URB. MONTEREY CALLE 1 D-6 | ||||||||
| Address2: | |||||||||
| City: | COROZAL | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877031449 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | AVENIDA LUIS MUNOS MARIN | ||||||||
| Address2: | ESQ DEGETAO | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876533434 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 4784 | PR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.