Provider Demographics
NPI:1477167054
Name:CONCILCO COLIN, JARIB TAKEZHI
Entity Type:Individual
Prefix:
First Name:JARIB
Middle Name:TAKEZHI
Last Name:CONCILCO COLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3862 SHERWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-4608
Mailing Address - Country:US
Mailing Address - Phone:310-985-9076
Mailing Address - Fax:
Practice Address - Street 1:3862 SHERWOOD PL
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-4608
Practice Address - Country:US
Practice Address - Phone:310-985-9076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
No171W00000XOther Service ProvidersContractor