Healthcare Provider Details

I. General information

NPI: 1912025800
Provider Name (Legal Business Name): FRANCES COLELLA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 MOUNTAIN VIEW ST
ALTADENA CA
91001-4925
US

IV. Provider business mailing address

1627 E MENDOCINO ST
ALTADENA CA
91001-2735
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-6793
  • Fax: 626-797-9035
Mailing address:
  • Phone: 626-798-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: