Active NPI
Luis Collazo, PHD
- Clinical Psychologist
- Guaynabo, PR
National Provider Identifier
1104081181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2953
- Practice address
- L4 Calle Bolivia
Oasis Gardens
Guaynabo, PR 00969-3413 - Phone
- (787) 525-2110
- NPI assigned
- Jul 19, 2008
- Last updated
- Feb 22, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2953 | PR | Primary |
Addresses
Primary practice location
L4 Calle Bolivia
Oasis Gardens
Guaynabo, PR 00969-3413
Mailing address
L4 Calle Bolivia
Oasis Gardens
Guaynabo, PR 00969-3413
Phone (787) 525-2110
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2953 | PR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235260800000",
"number": "1104081181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "L4 CALLE BOLIVIA",
"address_2": "OASIS GARDENS",
"city": "GUAYNABO",
"state": "PR",
"postal_code": "009693413",
"telephone_number": "787-525-2110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "L4 CALLE BOLIVIA",
"address_2": "OASIS GARDENS",
"city": "GUAYNABO",
"state": "PR",
"postal_code": "009693413",
"telephone_number": "787-525-2110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLAZO",
"first_name": "LUIS",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-19",
"last_updated": "2009-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PR",
"license": "2953",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Guaynabo, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.