Provider Demographics
NPI:1285940635
Name:COLVIN, RHONDA LOU (PA-C)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:LOU
Last Name:COLVIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 KROLL WAY
Mailing Address - Street 2:APT 167
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1109
Mailing Address - Country:US
Mailing Address - Phone:661-663-4861
Mailing Address - Fax:661-663-4871
Practice Address - Street 1:100 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-8823
Practice Address - Country:US
Practice Address - Phone:661-663-4966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51598193200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes193200000XGroupMulti-Specialty