Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSB94025373 | CA |
N | 103T00000X | Psychologist | PSB94025373 | CA |
Y | 103G00000X | Clinical Psychologist | PSB94025373 | CA |
Y | 103TC0700X | Clinical Psychologist | PSB94025373 | CA |
NPI | 1003428558 |
---|---|
Provider Name | Mr. Angelo Colaiacovo |
First Address | Monterey Park, CA 91754-7639 |
Second Address | Monterey Park, CA 91754-7639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2020 |
Last Update Date | 01/10/2020 |