Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A050788 | CA |
NPI | 1134148232 |
---|---|
Provider Name | Dr. Nicholas Colyvas |
First Address | Los Gatos, CA 95032-1417 |
Second Address | Los Gatos, CA 95032-1417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G40455 | (02) |