Healthcare Provider Details

I. General information

NPI: 1679803977
Provider Name (Legal Business Name): JONATHAN PATRICK COLL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 W PEDREGOSA ST APT A
SANTA BARBARA CA
93101-4622
US

IV. Provider business mailing address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

V. Phone/Fax

Practice location:
  • Phone: 805-708-7976
  • Fax:
Mailing address:
  • Phone: 562-933-1550
  • Fax: 562-933-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA 98153
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-129682
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: