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Individual
DR. ENRIQUE COLLANTES STA. ANA JR.
Active
Individual
DR. ENRIQUE COLLANTES STA. ANA JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11628
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000416134
MSBCBS
WV
05
—
0056202000
—
WV
01
—
550641245
FEIN
WV
Enumeration date
08/20/2006
Last updated
05/29/2015
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