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NPI Code Detail

MEDICARE: IRENE C COLETSOS M.D.

MEDICARE: IRENE C COLETSOS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician256535MA
22084P0800XPsychiatry PhysicianC196263CA

General Provider Information

NPI Number : 1013108869
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRENE C COLETSOS M.D.
Provider Business Mailing Address
First Line : 5333 MISSION CENTER RD STE 105
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1347
Country : US
Telephone Number : 619-997-4510
Fax Number : 619-984-5440
Provider Business Practice Location Address
First Line : 5333 MISSION CENTER RD STE 105
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1347
Country : US
Telephone Number : 619-997-4510
Fax Number : 619-984-5440
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2007
Last Update Date : 07/02/2024

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Directions to “ IRENE C COLETSOS M.D.” Practice Location

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