Provider Demographics
NPI:1053399931
Name:COLLAZO SANTIAGO, HYDEE L (MD)
Entity type:Individual
Prefix:DR
First Name:HYDEE
Middle Name:L
Last Name:COLLAZO SANTIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 691
Mailing Address - Street 2:
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723-0691
Mailing Address - Country:US
Mailing Address - Phone:787-315-5957
Mailing Address - Fax:787-839-8900
Practice Address - Street 1:207 CALLE MORSE
Practice Address - Street 2:HOSPITAL LAFAYETTE
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714-2350
Practice Address - Country:US
Practice Address - Phone:787-864-3494
Practice Address - Fax:787-864-3494
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-02
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14339204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021106Medicare ID - Type UnspecifiedPROVIDER