Healthcare Provider Details

I. General information

NPI: 1710269386
Provider Name (Legal Business Name): LIZA JIA COE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 W SUNSET BLVD UROLOGY DEPARTMENT 2ND FLOOR -STATION C
LOS ANGELES CA
90027-5814
US

IV. Provider business mailing address

4900 SUNSET BLVD UROLOGY DEPARTMENT 2ND FLOOR -STATION C
LOS ANGELES CA
90027
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-0487
  • Fax:
Mailing address:
  • Phone: 323-783-0487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number20439
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: