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General NPI Number Information
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NPI Number | 1942356548
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Entity Type | Individual
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Provider Name | AVANTA COLLIER MD
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 12462 PUTNAM ST UNIT 501
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City | WHITTIER
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State | CA
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Zip | 90602-1048
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Country | US
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Telephone | 562-789-5429
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Fax | 562-789-4441
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Provider Business Mailing Address
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Address Line | 12462 PUTNAM ST UNIT 501
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City | WHITTIER
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State | CA
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Zip | 90602-1048
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Country | US
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Telephone | 562-789-5429
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Fax | 562-789-4441
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 62961
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | C131378
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License Number State | CA
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