Healthcare Provider Details

I. General information

NPI: 1003428558
Provider Name (Legal Business Name): ANGELO COLAIACOVO PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 W CECIL AVE
DELANO CA
93215-1821
US

IV. Provider business mailing address

44750 60TH ST W
LANCASTER CA
93536-7619
US

V. Phone/Fax

Practice location:
  • Phone: 661-721-2345
  • Fax:
Mailing address:
  • Phone: 661-729-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSB94025373
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB94025373
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number34833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: