Individual
BERTHA COLLAZOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12401 ORANGE DR, SUITE 219, DAVIE, FL 33330-4341
(954) 862-1707
Mailing address
6875 COLLEGE CT, DAVIE, FL 33317-7164
(954) 593-8319
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001298400
—
FL
Enumeration date
07/11/2011
Last updated
07/11/2011
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