# ERNESTO L COLLAZO BATISTA MD PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376686782
- **Authorized official:** DR. ERNESTO LUIS COLLAZO M.D. (PRESIDENT)
- **Authorized official phone:** (787) 728-3700

## Contact information

- **Practice address:** 1503 CALLE PROF AUGUSTO RODRIGUE, SEGUNDO PISO, SANTURCE, PR 00909-2275
- **Practice address phone:** (787) 728-3700
- **Practice address fax:** (787) 728-4390
- **Mailing address:** PO BOX 366407, SAN JUAN, PR 00936-6407
- **Mailing address phone:** (787) 728-3700
- **Mailing address fax:** (787) 728-4390

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |
| 332H00000X | Eyewear Supplier | — | NULL | — |

## Other

- **Enumeration date:** 02/15/2007
- **Last updated:** 09/08/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 6133980002 | PTAN | PR |