Provider Demographics
NPI:1619587458
Name:COLLAZO-FONSECA, ANDREA CAROLINA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CAROLINA
Last Name:COLLAZO-FONSECA
Suffix:
Gender:F
Credentials:
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 6734
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6734
Mailing Address - Country:US
Mailing Address - Phone:787-539-5437
Mailing Address - Fax:
Practice Address - Street 1:URB. VISTA REAL 1, CALLE CANABONCITO
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-539-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program