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Individual
JEANETTE COLBERT
Active
Individual
JEANETTE COLBERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-098-4601
MEDI-CAL
CA
Enumeration date
04/07/2017
Last updated
04/07/2017
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