Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | ME0060851 | FL |
NPI | 1891748364 |
---|---|
Provider Name | Dr. Loudes Pila Collazo |
First Address | Miami, FL 33155-1335 |
Second Address | Miami, FL 33175-8100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 28/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
370505600 | (05) | FL |
F48599 | (02) | FL |