1245400480 NPI number — VIOLETA COLLAZO IRIZARRY

Table of content: (NPI 1245400480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245400480 NPI number — VIOLETA COLLAZO IRIZARRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIOLETA COLLAZO IRIZARRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245400480
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10369
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00732-0369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-841-6808
Provider Business Mailing Address Fax Number:
787-841-6808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE LAS AMERICAS 2431 EDIF A PORRATA PILA SUITE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-841-6808
Provider Business Practice Location Address Fax Number:
787-841-6808
Provider Enumeration Date:
03/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COLLAZO
Authorized Official First Name:
VIOLETA
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTICIAN
Authorized Official Telephone Number:
787-841-6808

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  066 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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