Provider Demographics
NPI:1134148232
Name:COLYVAS, NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:COLYVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:777 KNOWLES DR
Mailing Address - Street 2:SUITE # 9
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1417
Mailing Address - Country:US
Mailing Address - Phone:408-364-1673
Mailing Address - Fax:408-364-1635
Practice Address - Street 1:777 KNOWLES DR
Practice Address - Street 2:SUITE # 9
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1417
Practice Address - Country:US
Practice Address - Phone:408-364-1673
Practice Address - Fax:408-364-1635
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA050788207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G40455Medicare UPIN