Organization
SHANTHIMD DERMATOLOGY, INC.
Active
Organization
SHANTHIMD DERMATOLOGY, INC.
Active
Other names
ShanthiMD Dermatology, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANTHI MARIE COLACO MD (CEO/OWNER)
(323) 421-4747
Entity
Organization
Contact information
Practice address
2990 S SEPULVEDA BLVD, SUITE 300, LOS ANGELES, CA 90064-0002
(323) 421-4747
(949) 955-7351
Mailing address
2990 S SEPULVEDA BLVD, SUITE 300, LOS ANGELES, CA 90064-0002
(323) 421-4747
(949) 955-7351
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A123314
CA
207NS0135X
Procedural Dermatology Physician
A123314
CA
Other
Enumeration date
01/29/2016
Last updated
07/24/2024
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