MEDICARE: FARIDES COLPAS

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
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1205030681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARIDES COLPAS

Provider Business Mailing Address
First Line	:	916 NW 104TH AVE
Second Line	:	APT 102
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-3933
Country	:	US
Telephone Number	:	305-926-6163
Fax Number	:

Provider Business Practice Location Address
First Line	:	327 W 9TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-3853
Country	:	US
Telephone Number	:	305-863-2233
Fax Number	:	305-863-3296

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	07/08/2007

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Directions to “ FARIDES COLPAS ” Practice Location

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