Healthcare Provider Details

I. General information

NPI: 1518939263
Provider Name (Legal Business Name): ANA CAROLINA COLL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MINERAL KING AVE
VISALIA CA
93291-6237
US

IV. Provider business mailing address

5211 W GOSHEN AVE
VISALIA CA
93291-8619
US

V. Phone/Fax

Practice location:
  • Phone: 800-717-5670
  • Fax: 866-757-9283
Mailing address:
  • Phone: 559-732-5290
  • Fax: 559-732-5674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA69365
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA69365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: