Provider Demographics
NPI:1538706064
Name:COLDAGELLI, MARIA-RENEE J (MS LCGC)
Entity Type:Individual
Prefix:
First Name:MARIA-RENEE
Middle Name:J
Last Name:COLDAGELLI
Suffix:
Gender:F
Credentials:MS LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19611 N 64TH LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7048
Mailing Address - Country:US
Mailing Address - Phone:708-953-9170
Mailing Address - Fax:
Practice Address - Street 1:701 GATEWAY BLVD STE 380
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-7420
Practice Address - Country:US
Practice Address - Phone:776-880-9928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS