Healthcare Provider Details

I. General information

NPI: 1487912390
Provider Name (Legal Business Name): MR. HARLAN KEITH COFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7961 VALLEY VIEW ST
LA PALMA CA
90623-1848
US

IV. Provider business mailing address

7961 VALLEY VIEW ST
LA PALMA CA
90623-1848
US

V. Phone/Fax

Practice location:
  • Phone: 714-868-8544
  • Fax:
Mailing address:
  • Phone: 714-868-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number56951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: