Healthcare Provider Details

I. General information

NPI: 1720219165
Provider Name (Legal Business Name): JOSE MANUEL COLOM R.N.BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 98TH ST #23
BAY HARBOR ISLANDS FL
33154-3816
US

IV. Provider business mailing address

1060 98TH ST #23
BAY HARBOR ISLANDS FL
33154-3816
US

V. Phone/Fax

Practice location:
  • Phone: 786-285-6801
  • Fax:
Mailing address:
  • Phone: 786-285-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9286363
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: