Provider Demographics
NPI:1184440752
Name:COLANSONG, JASMIN MELCHOR
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:MELCHOR
Last Name:COLANSONG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10565 CIVIC CENTER DR STE 250
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3854
Mailing Address - Country:US
Mailing Address - Phone:626-696-1471
Mailing Address - Fax:626-696-1451
Practice Address - Street 1:10565 CIVIC CENTER DR BLDG STE 165
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3853
Practice Address - Country:US
Practice Address - Phone:909-985-2211
Practice Address - Fax:909-985-2244
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-28
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily