Healthcare Provider Details

I. General information

NPI: 1093490377
Provider Name (Legal Business Name): DAJOUR TRAVIS PAUL COLLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W OLIVE AVE
MERCED CA
95348-2427
US

IV. Provider business mailing address

3790 HORIZONS AVE APT H203
MERCED CA
95348-9691
US

V. Phone/Fax

Practice location:
  • Phone: 209-437-9410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME177323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: