Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 14339 | PR |
NPI | 1053399931 |
---|---|
Provider Name | Dr. Hydee L Collazo Santiago |
First Address | Patillas, PR 00723-0691 |
Second Address | Arroyo, PR 00714-2350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2006 |
Last Update Date | 20/09/2016 |