Provider Demographics
NPI:1336505007
Name:COLEMAN, COLLEEN (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W FOOTHILL BLVD STE C
Mailing Address - Street 2:#125
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3356
Mailing Address - Country:US
Mailing Address - Phone:909-230-2178
Mailing Address - Fax:
Practice Address - Street 1:915 W FOOTHILL BLVD STE C
Practice Address - Street 2:#125
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3356
Practice Address - Country:US
Practice Address - Phone:909-230-2178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53014207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine