1376686782 NPI number — ERNESTO L COLLAZO BATISTA MD PSC

Table of content: (NPI 1376686782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376686782 NPI number — ERNESTO L COLLAZO BATISTA MD PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERNESTO L COLLAZO BATISTA MD PSC
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:
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:
1376686782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 366407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-6407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-728-3700
Provider Business Mailing Address Fax Number:
787-728-4390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1503 CALLE PROF AUGUSTO RODRIGUE
Provider Second Line Business Practice Location Address:
SEGUNDO PISO
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909-2275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-728-3700
Provider Business Practice Location Address Fax Number:
787-728-4390
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLLAZO
Authorized Official First Name:
ERNESTO
Authorized Official Middle Name:
LUIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-728-3700

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 6133980002 . This is a "PTAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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