Provider Demographics
NPI:1558969337
Name:ENGBER, COLTER
Entity Type:Individual
Prefix:
First Name:COLTER
Middle Name:
Last Name:ENGBER
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 1:3486 GOLDEN STATE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-4611
Mailing Address - Country:US
Mailing Address - Phone:669-241-9430
Mailing Address - Fax:
Practice Address - Street 1:3486 GOLDEN STATE DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-4611
Practice Address - Country:US
Practice Address - Phone:669-241-9430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program