Provider Demographics
NPI:1891974960
Name:COLOMBO, ANGELA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIA
Last Name:COLOMBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:MARIA
Other - Last Name:GRAMMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27762 ANTONIO PKWY L1 #325
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1247
Mailing Address - Country:US
Mailing Address - Phone:949-235-8835
Mailing Address - Fax:
Practice Address - Street 1:20072 SW BIRCH ST STE 190
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0799
Practice Address - Country:US
Practice Address - Phone:949-354-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine