Healthcare Provider Details

I. General information

NPI: 1225995384
Provider Name (Legal Business Name): NICHOLAS COLONNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E MAIN ST STE 117
BARSTOW CA
92311-2365
US

IV. Provider business mailing address

20258 US HIGHWAY 18 STE 430-275
APPLE VALLEY CA
92307-6197
US

V. Phone/Fax

Practice location:
  • Phone: 760-255-1496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: