Individual provider Active NPI

Keith Colder

  • Peer Specialist
  • Pomona, CA
National Provider Identifier
1114816774
Registry record updated Jun 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Peer SpecialistTaxonomy code 175T00000X
License
MPSS-GEDXBK Issued in CA
Practice address
1900 Royalty Dr Ste 180
Pomona, CA 91767-3046
Phone
(909) 766-7340
Fax
(909) 865-0730
NPI assigned
Jun 30, 2025
Last updated
Jun 30, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X MPSS-GEDXBK CA Primary

Addresses

Primary practice location

1900 Royalty Dr Ste 180
Pomona, CA 91767-3046

Mailing address

1900 Royalty Dr Ste 180
Pomona, CA 91767-3046
Phone (909) 766-7340

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MPSS-GEDXBKCAMDPeer Specialist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751241600000",
    "number": "1114816774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 ROYALTY DR STE 180",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673046",
            "telephone_number": "909-766-7340",
            "fax_number": "909-865-0730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 ROYALTY DR STE 180",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673046",
            "telephone_number": "909-766-7340",
            "fax_number": "909-865-0730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLDER",
        "first_name": "KEITH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-06-30",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "CA",
            "license": "MPSS-GEDXBK",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.