Provider Demographics
NPI:1639369416
Name:COLON, RUBEN GABRIEL (ACSW)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:GABRIEL
Last Name:COLON
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 LUZ AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-2051
Mailing Address - Country:US
Mailing Address - Phone:408-655-0200
Mailing Address - Fax:
Practice Address - Street 1:2190 LUZ AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-2051
Practice Address - Country:US
Practice Address - Phone:408-655-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW945991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty