Provider Demographics
NPI:1942548656
Name:COLLADO, ANGELO B (PTA)
Entity Type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:B
Last Name:COLLADO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2615
Mailing Address - Country:US
Mailing Address - Phone:626-841-1290
Mailing Address - Fax:
Practice Address - Street 1:408 N WABASH AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-2615
Practice Address - Country:US
Practice Address - Phone:626-841-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT2479171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor