Healthcare Provider Details

I. General information

NPI: 1588989487
Provider Name (Legal Business Name): ALVIN BOB CODA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10820 N TORREY PINES RD # MS 128
LA JOLLA CA
92037-1036
US

IV. Provider business mailing address

8899 UNIVERSITY CENTER LN SUITE 350
SAN DIEGO CA
92122-1013
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-8645
  • Fax:
Mailing address:
  • Phone: 858-657-8322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA118265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: