Provider Demographics
NPI:1386888550
Name:COLLINS, JUAN CARLOS (LAC)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:COLLINS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3859 20TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3018
Mailing Address - Country:US
Mailing Address - Phone:415-641-1939
Mailing Address - Fax:
Practice Address - Street 1:211 GOUGH ST
Practice Address - Street 2:SUITE 204-205
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5946
Practice Address - Country:US
Practice Address - Phone:415-641-1939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist