Provider Demographics
NPI:1063005361
Name:COLMUS, SION
Entity type:Individual
Prefix:
First Name:SION
Middle Name:
Last Name:COLMUS
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 1:2131 E BROADWAY RD STE 14
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1737
Mailing Address - Country:US
Mailing Address - Phone:480-570-6103
Mailing Address - Fax:
Practice Address - Street 1:4079 PINTO RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-7218
Practice Address - Country:US
Practice Address - Phone:928-264-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12796589253J00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes253J00000XAgenciesFoster Care Agency