Healthcare Provider Details

I. General information

NPI: 1841474368
Provider Name (Legal Business Name): MR. DAVID A COLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44447 10TH STREET WEST
LANCASTER CA
93534
US

IV. Provider business mailing address

9150 EAST IMPERIAL HWY ROOM P31
DOWNEY CA
90242
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-2630
  • Fax: 661-942-4692
Mailing address:
  • Phone: 661-726-2630
  • Fax: 661-942-4692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: