Provider Demographics
NPI:1073693842
Name:COLLADO, RUBEN (CNP)
Entity Type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:
Last Name:COLLADO
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 PEARL LOOP
Mailing Address - Street 2:
Mailing Address - City:BOSQUE FARMS
Mailing Address - State:NM
Mailing Address - Zip Code:87068-9036
Mailing Address - Country:US
Mailing Address - Phone:505-217-4150
Mailing Address - Fax:505-869-4907
Practice Address - Street 1:1835 PEARL LOOP
Practice Address - Street 2:
Practice Address - City:BOSQUE FARMS
Practice Address - State:NM
Practice Address - Zip Code:87068-9036
Practice Address - Country:US
Practice Address - Phone:505-217-4150
Practice Address - Fax:505-869-4907
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR17420363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
8HBQ87Medicare UPIN