Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | G31991 | CA |
NPI | 1578502639 |
---|---|
Provider Name | Dr. Patrick Michael Colletti |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 21/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A44946 | (02) | CA |