Healthcare Provider Details

I. General information

NPI: 1043400286
Provider Name (Legal Business Name): COLUZZI & TETEF MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4746 BARRANCA PKWY
IRVINE CA
92604-4728
US

IV. Provider business mailing address

4746 BARRANCA PKWY
IRVINE CA
92604-4728
US

V. Phone/Fax

Practice location:
  • Phone: 949-653-9013
  • Fax:
Mailing address:
  • Phone: 949-653-9013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARISA CASANOVA
Title or Position: CLIENT SERVICE REP
Credential:
Phone: 714-619-5450