Provider Demographics
NPI:1124391685
Name:COLKETT, ARYN SUZANNE (LAC)
Entity Type:Individual
Prefix:
First Name:ARYN
Middle Name:SUZANNE
Last Name:COLKETT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:NAYA
Other - Middle Name:
Other - Last Name:COLKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:3432 GUIDO ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-3527
Mailing Address - Country:US
Mailing Address - Phone:858-699-1280
Mailing Address - Fax:
Practice Address - Street 1:6613 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1115
Practice Address - Country:US
Practice Address - Phone:858-699-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14301171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist