Provider Demographics
NPI:1598637308
Name:COLLADO, CHARMAINE C
Entity type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:C
Last Name:COLLADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 SAINT LOUIS CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3929
Mailing Address - Country:US
Mailing Address - Phone:510-861-8058
Mailing Address - Fax:
Practice Address - Street 1:921 SAINT LOUIS CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3929
Practice Address - Country:US
Practice Address - Phone:510-861-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7009991740376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty