Provider Demographics
NPI:1265412118
Name:ARMANDO JAMES COLLAZO LEANDRY CSP
Entity type:Organization
Organization Name:ARMANDO JAMES COLLAZO LEANDRY CSP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:COLLAZO LEANDRY CSP
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-844-6165
Mailing Address - Street 1:BOX 7469
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732
Mailing Address - Country:US
Mailing Address - Phone:787-844-6165
Mailing Address - Fax:787-844-6130
Practice Address - Street 1:PARRA BUILDING 2225 PONCE BY PASS
Practice Address - Street 2:STE 409
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1322
Practice Address - Country:US
Practice Address - Phone:787-844-6165
Practice Address - Fax:787-844-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6554207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79608Medicare UPIN
PR27003Medicare ID - Type Unspecified