Provider Demographics
NPI:1538273008
Name:COLINA, KENNETH F (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:F
Last Name:COLINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 CHILDRENS WAY # MC5064
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-5841
Mailing Address - Fax:
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-966-5841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3298208000000X, 208M00000X
CA153469208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110625102OtherFIRSTCARE PIN
TX125007806Medicaid
TX140442852Medicaid
TX1218867OtherFIRSTHEALTH PIN
TX124106OtherSUPERIOR PIN
TX88705GOtherBCBSTX IND PIN
TX00U87ZOtherBCBSTX GRP PIN
1750369203OtherGRP NPI NUMBER
TX2352398OtherUHC PIN
TX4536787OtherAETNA PIN
TX7097804OtherCIGNA PIN
TX137345810Medicaid
TX10011558OtherAMERIGROUP PIN
TX125007805Medicaid
TX10011558OtherAMERIGROUP PIN
TX1218867OtherFIRSTHEALTH PIN
TX8A9447Medicare PIN