Provider Demographics
NPI:1659879294
Name:ZADRA, COLLIN ANTHONY (BA)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:ANTHONY
Last Name:ZADRA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 VIA CENTRE DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081
Mailing Address - Country:US
Mailing Address - Phone:760-294-1206
Mailing Address - Fax:
Practice Address - Street 1:1926 VIA CENTRE DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081
Practice Address - Country:US
Practice Address - Phone:760-294-1206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician