Provider Demographics
NPI:1053526723
Name:COLLADO, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:COLLADO
Suffix:
Gender:M
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:#164 SAUCE
Mailing Address - Street 2:URB. EL VALLE
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-2523
Mailing Address - Country:US
Mailing Address - Phone:787-598-2016
Mailing Address - Fax:787-831-4239
Practice Address - Street 1:14ST.BO.MACHUELOS
Practice Address - Street 2:CENTRO DE METADONA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732-7321
Practice Address - Country:US
Practice Address - Phone:787-840-6935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13974208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice