Healthcare Provider Details

I. General information

NPI: 1437361151
Provider Name (Legal Business Name): SANDRA D. COCO M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17524 E JACKRABBIT RD
SPRING VALLEY AZ
86333-4330
US

IV. Provider business mailing address

17524 E JACKRABBIT RD
SPRING VALLEY AZ
86333-4330
US

V. Phone/Fax

Practice location:
  • Phone: 928-606-4903
  • Fax:
Mailing address:
  • Phone: 928-606-4903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD0040
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: