Healthcare Provider Details

I. General information

NPI: 1265267835
Provider Name (Legal Business Name): MR. MARK ANDREW COYER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 RICHLAND AVE # C
CERES CA
95307-4562
US

IV. Provider business mailing address

2521 ROSE HILL LN
RIVERBANK CA
95367-9585
US

V. Phone/Fax

Practice location:
  • Phone: 209-541-2556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: