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General NPI Number Information
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NPI Number | 1255431722
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Entity Type | Individual
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Provider Name | HECTOR EDUARDO COLLANTES JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 13425 INGLEWOOD AVENUE
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City | HAWTHORNE
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State | CA
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Zip | 90250
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Country | US
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Telephone | 310-679-2201
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Fax | 310-679-4236
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Provider Business Mailing Address
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Address Line | 824 E CARSON ST STE 201
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City | CARSON
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State | CA
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Zip | 90745-2262
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Country | US
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Telephone | 310-326-1579
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA15273
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License Number State | CA
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