Shanthi Marie Colaco, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A123314 Issued in CA

Practice address

2990 S Sepulveda Blvd
Suite 300
Los Angeles, CA 90064-0002

Phone

(323) 421-4747

Fax

(949) 955-7351

NPI assigned

Jun 30, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

University of California, San Francisco School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shanthimd Dermatology, Inc.

  • Dermatology Physician
  • Los Angeles, CA
  • NPI 1245698752
  Medicare reassignment Authorized official
• Alexander Rabinovich Medical PC

  • Ophthalmology Physician
  • Brooklyn, NY
  • NPI 1962735589
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1144482167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2990 S SEPULVEDA BLVD STE 300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900640002",
            "telephone_number": "323-421-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 S SEPULVEDA BLVD",
            "address_2": "SUITE 300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900640002",
            "telephone_number": "323-421-4747",
            "fax_number": "949-955-7351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLACO",
        "first_name": "SHANTHI",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-30",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A123314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deanna Suzanne Coker, BCBA
• Ivy Bartholomew Coker
• Jason Randolph Coker, D.O.
• Col Pharmaceutical Inc (COL Pharmacy)
• Adil Amirali Colabawala
• Vanessa Maria Colaco, PHARMD
• Alexander F Colanero, D.C.
• Stephanie Colantonio, MD
• Erin Colantuono, NP
• Latonia Colas

• Dermatology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.