Provider Demographics
NPI:1003428558
Name:COLAIACOVO, ANGELO (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:
Last Name:COLAIACOVO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44750 60TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-7619
Mailing Address - Country:US
Mailing Address - Phone:661-729-2000
Mailing Address - Fax:
Practice Address - Street 1:2737 W CECIL AVE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-1821
Practice Address - Country:US
Practice Address - Phone:661-721-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94025373103T00000X, 103TC0700X
CA390200000X
CA34833103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program