Gerardo Israel Collazo Malave Sr., MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

22394 Issued in PR

Practice address

Recinto de Ciencias Medicas Upr
Departamento de Psiquiatria
San Juan, PR 00921

Phone

(787) 243-5979

NPI assigned

Oct 8, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sheppard Pratt Physicians, P.a.

  • Psychiatry Physician
  • Baltimore, MD
  • NPI 1518990712
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1417422353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "B55 CALLE SANCHEZ",
            "address_2": "URB APONTE",
            "city": "CAYEY",
            "state": "PR",
            "postal_code": "00736",
            "telephone_number": "787-243-5979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RECINTO DE CIENCIAS MEDICAS UPR",
            "address_2": "DEPARTAMENTO DE PSIQUIATRIA",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00921",
            "telephone_number": "787-243-5979"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "B55 Calle Sanchez",
            "address_2": "Urb Aponte",
            "address_purpose": "LOCATION",
            "city": "Cayey",
            "state": "PR",
            "postal_code": "007360073",
            "country_code": "US",
            "telephone_number": "787-243-5979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLLAZO MALAVE",
        "first_name": "GERARDO",
        "middle_name": "ISRAEL",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-08",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PR",
            "license": "35019",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "PR",
            "license": "22394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yahaira E. Collado, B.A.S.W
• Keischaly Collazo Aparicio
• Bryan Joel Collazo Barbosa
• Laura Michelle Collazo Estrada
• Patricia Collazo Lopez
• Mariangelys Collazo Rivera
• Ramon Luis Collazo-Bigles Sr., MD
• Diego Enrique Collazo-Irizarry, B.SC.
• Lilymar Collazo-Mojica, PH.D.
• Carmen I Collazo-Vazquez

• Child & Adolescent Psychiatry Physician in San Juan, PR
• Providers in San Juan, PR by specialty
• Child & Adolescent Psychiatry Physician in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.