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NPI Code Detail

MEDICARE: DEAN MASON COFFEY PSY.D.

MEDICARE:   DEAN MASON COFFEY  PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY 20589CA

General Provider Information

NPI Number : 1598807307
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEAN MASON COFFEY PSY.D.
Provider Business Mailing Address
First Line : 4650 W SUNSET BLVD
Second Line : MS #115
City : LOS ANGELES
State : CA
Zip : 90027-6062
Country : US
Telephone Number : 323-361-3849
Fax Number : 323-644-8305
Provider Business Practice Location Address
First Line : 3250 WILSHIRE BLVD
Second Line : SUITE 500
City : LOS ANGELES
State : CA
Zip : 90010-1577
Country : US
Telephone Number : 323-361-3849
Fax Number : 323-644-8305
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 07/08/2007

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