Provider Demographics
NPI:1922160399
Name:COLOSI, THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:COLOSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 321034
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-0117
Mailing Address - Country:US
Mailing Address - Phone:408-356-4774
Mailing Address - Fax:408-358-8692
Practice Address - Street 1:14901 NATIONAL AVE 101
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2637
Practice Address - Country:US
Practice Address - Phone:408-356-4774
Practice Address - Fax:408-358-8692
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66895207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF37141Medicare UPIN