Mayra M. Collazo, M.D., CTR

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

17368 Issued in PR

Practice address

52 Calle 2
Paseo Alto
San Juan, PR 00926-5918

Phone

(787) 653-3434

Fax

(787) 653-1314

NPI assigned

Nov 10, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PR

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

Certified Tumor Registrar, Doctor of Medicine

State licenses

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

{
    "created_epoch": "1226275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1477707040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6689",
            "city": "CAGUAS",
            "state": "PR",
            "postal_code": "007266689",
            "telephone_number": "787-362-4440",
            "fax_number": "787-653-1314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 CALLE 2",
            "address_2": "PASEO ALTO",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009265918",
            "telephone_number": "787-653-3434",
            "fax_number": "787-653-1314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLAZO",
        "first_name": "MAYRA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "M.D., CTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-11-10",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "17368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASSMCA",
            "identifier": "DM-17324-5",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Griselle Collazo, O.T.
• Jesus Arturo Collazo, R.PH.
• Joaquin Collazo
• Luis E. Collazo, R.PH.
• Luisa M Collazo, M.D.
• Shirleen M Collazo, PH.D
• Ana T Colmenero
• Jose Luis Colmenero, DMD
• Heydi Colon Alicea, OTL
• Regino Colon Alsina, M.D.

• General Practice Physician in San Juan, PR
• Providers in San Juan, PR by specialty
• General Practice Physician in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.