Provider Demographics
NPI:1174584767
Name:COLLADO ROSAS, IRVIN (MD)
Entity type:Individual
Prefix:
First Name:IRVIN
Middle Name:
Last Name:COLLADO ROSAS
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:PO BOX 1059
Mailing Address - Street 2:16 NELSON PEREA STREET
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1059
Mailing Address - Country:US
Mailing Address - Phone:787-265-3650
Mailing Address - Fax:787-832-2533
Practice Address - Street 1:16 CALLE NELSON PEREA
Practice Address - Street 2:16 NELSON PEREA STREET
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4948
Practice Address - Country:US
Practice Address - Phone:787-265-3650
Practice Address - Fax:787-832-2533
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9414207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRB21936Medicare UPIN
PR81489Medicare ID - Type Unspecified