Healthcare Provider Details

I. General information

NPI: 1750568358
Provider Name (Legal Business Name): PATRICIA COGHLAN, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 WILSHIRE BLVD STE 403
LOS ANGELES CA
90017-3905
US

IV. Provider business mailing address

1127 WILSHIRE BLVD STE 403
LOS ANGELES CA
90017-3905
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-2083
  • Fax: 213-482-5613
Mailing address:
  • Phone: 213-481-2083
  • Fax: 213-482-5613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA22797
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA22797
License Number StateCA

VIII. Authorized Official

Name: MARCIA THOMPSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 805-482-7342