Healthcare Provider Details

I. General information

NPI: 1710218474
Provider Name (Legal Business Name): GINA MARIE COLLIER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 J ST 260
SACRAMENTO CA
95819-3624
US

IV. Provider business mailing address

1010 HURLEY WAY 500
SACRAMENTO CA
95825-3215
US

V. Phone/Fax

Practice location:
  • Phone: 916-736-2323
  • Fax: 916-736-0620
Mailing address:
  • Phone: 916-564-3040
  • Fax: 916-564-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number19452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: