Provider Demographics
NPI:1912686353
Name:COLUNGA, NICOLAS EMILIANO I
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:EMILIANO
Last Name:COLUNGA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 YOUNGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-9707
Mailing Address - Country:US
Mailing Address - Phone:209-667-0327
Mailing Address - Fax:209-669-8466
Practice Address - Street 1:2513 YOUNGSTOWN RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-9707
Practice Address - Country:US
Practice Address - Phone:209-667-0327
Practice Address - Fax:209-669-8466
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator