Provider Demographics
NPI:1134683618
Name:COLAS, IAN
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:COLAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 THOMAS CIR
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-1857
Mailing Address - Country:US
Mailing Address - Phone:917-402-8934
Mailing Address - Fax:
Practice Address - Street 1:1425 SOUTH MAIN STREET , WALNUT CREEK
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:925-295-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2278P3900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2278P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedNeonatal/Pediatrics