Provider Demographics
NPI:1144751322
Name:COLVIN, DESTINI
Entity Type:Individual
Prefix:
First Name:DESTINI
Middle Name:
Last Name:COLVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 GARDEN RD
Mailing Address - Street 2:SUITE 201-A
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5338
Mailing Address - Country:US
Mailing Address - Phone:831-658-3811
Mailing Address - Fax:831-658-3815
Practice Address - Street 1:2560 GARDEN RD
Practice Address - Street 2:SUITE 201-A
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5338
Practice Address - Country:US
Practice Address - Phone:831-658-3811
Practice Address - Fax:831-658-3815
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator