Colleen Marie Bacon, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

357546 Issued in CA

Practice address

30210 Rancho Viejo Rd
San Juan Capistrano, CA 92675-1574

Phone

(949) 493-7337

Fax

(949) 493-1418

NPI assigned

Aug 8, 2011

Last updated

May 26, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Coastal Kids, a Professional Medical Corporation

  dba Coastal Kids

  • Pediatrics Physician
  • Newport Beach, CA
  • NPI 1740311737
  NPD

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

{
    "created_epoch": "1312761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653523200000",
    "number": "1184903270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24422 AVENIDA DE LA CARLOTA STE 300",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533628",
            "telephone_number": "949-599-2434",
            "fax_number": "949-599-2430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30210 RANCHO VIEJO RD",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751574",
            "telephone_number": "949-493-7337",
            "fax_number": "949-493-1418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "COLLEEN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-08",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "357546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Axos Acupuncture Inc
• Azadeh Sofiya Azmoudeh
• Kiara Harmony Azuma
• B. Omrani DDS Inc (Platinum Dental Group)
• B&S Consulting
• Melody A Bacon, PH.D.
• Ronald A. Bacon, M.A., M.DIV.
• Sandra Lee Baggett, RADT-1
• Samantha A. Bahnam
• Brynn Christin Bailey, MS, PA-C

• Family Nurse Practitioner in San Juan Capistrano, CA
• Providers in San Juan Capistrano, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; 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.