Provider Demographics
NPI:1245119759
Name:KOLB, MARK (RN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:KOLB
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1011 CAMINO DEL RIO S
Mailing Address - Street 2:STE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3567
Mailing Address - Country:US
Mailing Address - Phone:619-287-8225
Mailing Address - Fax:619-393-0386
Practice Address - Street 1:1011 CAMINO DEL RIO S STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3567
Practice Address - Country:US
Practice Address - Phone:619-287-8225
Practice Address - Fax:619-287-8225
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA556604163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse