Healthcare Provider Details

I. General information

NPI: 1538977764
Provider Name (Legal Business Name): GIOVANNI MATTEO COLELLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 MISSION ST APT 14B
SAN FRANCISCO CA
94103-3162
US

IV. Provider business mailing address

706 MISSION ST APT 14B
SAN FRANCISCO CA
94103-3162
US

V. Phone/Fax

Practice location:
  • Phone: 415-519-5814
  • Fax:
Mailing address:
  • Phone: 415-519-5814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberA48160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: