Healthcare Provider Details

I. General information

NPI: 1285940635
Provider Name (Legal Business Name): RHONDA LOU COLVIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OLD RIVER RD
BAKERSFIELD CA
93311-8823
US

IV. Provider business mailing address

8200 KROLL WAY APT 167
BAKERSFIELD CA
93311-1109
US

V. Phone/Fax

Practice location:
  • Phone: 661-663-4966
  • Fax:
Mailing address:
  • Phone: 661-663-4861
  • Fax: 661-663-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code193200000X
TaxonomyMulti-Specialty Group
License Number51598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: