Provider Demographics
NPI:1659621639
Name:COLON, VINICIO RAFAEL JR (LVN)
Entity Type:Individual
Prefix:MR
First Name:VINICIO
Middle Name:RAFAEL
Last Name:COLON
Suffix:JR
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-2603
Mailing Address - Country:US
Mailing Address - Phone:530-604-6334
Mailing Address - Fax:
Practice Address - Street 1:1670 MARKET ST
Practice Address - Street 2:SUITE 246
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1038
Practice Address - Country:US
Practice Address - Phone:530-243-4100
Practice Address - Fax:530-243-4144
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN262917164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse