MEDICARE: DR. ANGELA VENETIS-COLON PH.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
1	103TC0700X	Clinical Psychologist	PSY21455	CA

General Provider Information

NPI Number	:	1396087326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA VENETIS-COLON PH.D.

Provider Business Mailing Address
First Line	:	5131 W MENLO AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-3644
Country	:	US
Telephone Number	:	559-385-0540
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 E COLORADO BLVD STE 180&2ND
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-6143
Country	:	US
Telephone Number	:	559-385-0540
Fax Number	:

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

Provider Enumeration Date	:	03/15/2013
Last Update Date	:	07/25/2023

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