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NPI Code Detail

MEDICARE: COLLABRIA CARE

MEDICARE: COLLABRIA CARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251T00000XPACE Provider Organization

General Provider Information

NPI Number : 1700505617
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLLABRIA CARE
Provider Business Mailing Address
First Line : PO BOX 31001-3064
Second Line :
City : PASADENA
State : CA
Zip : 91110-3064
Country : US
Telephone Number : 707-254-4159
Fax Number : 707-699-1557
Provider Business Practice Location Address
First Line : 414 S JEFFERSON ST
Second Line :
City : NAPA
State : CA
Zip : 94559-4515
Country : US
Telephone Number : 707-254-4159
Fax Number : 707-699-1557
Authorized Official
Title or Position : ASSISTANT SECRETARY OF ENROLLMENTS
Name : MR. DONALD W ANDERSON JR.
Credential :
Telephone Number : 425-358-9786
Provider Enumeration Date : 08/24/2022
Last Update Date : 05/14/2025

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Directions to “COLLABRIA CARE ” Practice Location

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