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General NPI Number Information
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NPI Number | 1184440752
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Entity Type | Individual
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Provider Name | JASMIN MELCHOR COLANSONG
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Gender | Female
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Dates
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Enumeration Date | 11/28/2024
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Last Update Date | 03/16/2025
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Provider Practice Location Address
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Address Line | 10565 CIVIC CENTER DR BLDG STE 165
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3853
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Country | US
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Telephone | 909-985-2211
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Fax | 909-985-2244
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Provider Business Mailing Address
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Address Line | 10565 CIVIC CENTER DR STE 250
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3854
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Country | US
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Telephone | 626-696-1471
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Fax | 626-696-1451
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95031252
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License Number State | CA
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