Provider Demographics
NPI:1215407580
Name:COLON, ANDREA MARIE (ND)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARIE
Last Name:COLON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 PARK NEWPORT APT 301
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6033
Mailing Address - Country:US
Mailing Address - Phone:401-212-0084
Mailing Address - Fax:
Practice Address - Street 1:2121 E COAST HWY STE 210
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-1934
Practice Address - Country:US
Practice Address - Phone:949-891-1693
Practice Address - Fax:949-861-9109
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND1107175F00000X
CT636175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath