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General NPI Number Information
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NPI Number | 1932405081
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Entity Type | Individual
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Provider Name | CLINTON GILBERT COLACO MD
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Gender | Male
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 10666 N TORREY PINES RD # 207W
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City | LA JOLLA
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State | CA
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Zip | 92037
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Country | US
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Telephone | 858-824-5824
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Fax | 858-554-8492
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Provider Business Mailing Address
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Address Line | 10790 RANCHO BERNARDO RD
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City | SAN DIEGO
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State | CA
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Zip | 92127-5705
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Country | US
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Telephone | 858-824-5824
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Fax | 858-554-8492
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | A149930
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | A149930
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | A149930
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License Number State | CA
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