Healthcare Provider Details

I. General information

NPI: 1275067142
Provider Name (Legal Business Name): NATHAN LOUIS COLON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SUPERIOR AVE STE 200F
NEWPORT BEACH CA
92663-3664
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 949-999-8979
  • Fax: 949-999-8970
Mailing address:
  • Phone: 314-362-8200
  • Fax: 314-454-5244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2023019454
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA203125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: