Basic Information
| Provider Information | |||||||||
| NPI: | 1891244422 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIRIAZES | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | MEGAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 THOMPSON AVE APT D | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912014008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059927891 | ||||||||
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| Practice Location | |||||||||
| Address1: | 808 W 58TH ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235411411 | ||||||||
| FaxNumber: | 8777207181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2016 | ||||||||
| LastUpdateDate: | 05/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.