Provider Demographics
NPI:1891244422
Name:KIRIAZES, COLLEEN MEGAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:MEGAN
Last Name:KIRIAZES
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:330 THOMPSON AVE APT D
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-4008
Mailing Address - Country:US
Mailing Address - Phone:305-992-7891
Mailing Address - Fax:
Practice Address - Street 1:808 W 58TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037
Practice Address - Country:US
Practice Address - Phone:323-541-1411
Practice Address - Fax:877-720-7181
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2018-05-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical