Provider Demographics
NPI:1811029168
Name:DIAS, COLIN PORUS (MD)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:PORUS
Last Name:DIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:COLIN
Other - Middle Name:P
Other - Last Name:DIAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:30101 AGOURA CT STE 100
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4301
Mailing Address - Country:US
Mailing Address - Phone:818-879-9018
Mailing Address - Fax:818-879-9013
Practice Address - Street 1:30101 AGOURA CT STE 100
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4301
Practice Address - Country:US
Practice Address - Phone:818-879-9018
Practice Address - Fax:818-879-9013
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA843212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry