Healthcare Provider Details

I. General information

NPI: 1871920355
Provider Name (Legal Business Name): BEATRIZ COLL CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHITNEY AVE
VALLEJO CA
94589-2194
US

IV. Provider business mailing address

1715 9TH ST
BERKELEY CA
94710-1836
US

V. Phone/Fax

Practice location:
  • Phone: 707-556-8921
  • Fax:
Mailing address:
  • Phone: 510-435-3695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number21000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: