Provider Demographics
NPI:1720219165
Name:COLOM, JOSE MANUEL (RNBSN)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MANUEL
Last Name:COLOM
Suffix:
Gender:M
Credentials:RNBSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 98TH ST
Mailing Address - Street 2:#23
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-3816
Mailing Address - Country:US
Mailing Address - Phone:786-285-6801
Mailing Address - Fax:
Practice Address - Street 1:1060 98TH ST
Practice Address - Street 2:#23
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-3816
Practice Address - Country:US
Practice Address - Phone:786-285-6801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9286363163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse