Provider Demographics
NPI:1538196720
Name:CRESPO COLLAZO, MARIBEL (MD)
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:CRESPO COLLAZO
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 1:655 CALLEJON C
Mailing Address - Street 2:VENUS GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-4523
Mailing Address - Country:US
Mailing Address - Phone:787-995-1902
Mailing Address - Fax:787-268-7271
Practice Address - Street 1:655 CALLEJON C
Practice Address - Street 2:VENUS GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-4523
Practice Address - Country:US
Practice Address - Phone:787-995-1902
Practice Address - Fax:787-268-7271
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine