Healthcare Provider Details

I. General information

NPI: 1841435526
Provider Name (Legal Business Name): COGGINS AND LEVY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15559 UNION AVE #130
LOS GATOS CA
95032-3904
US

IV. Provider business mailing address

15559 UNION AVE SUITE #130
LOS GATOS CA
95032-3904
US

V. Phone/Fax

Practice location:
  • Phone: 408-879-5900
  • Fax:
Mailing address:
  • Phone: 408-369-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberG58266
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA61490
License Number StateCA

VIII. Authorized Official

Name: DWAIN L COGGINS
Title or Position: PARTNER
Credential: M.D.
Phone: 408-369-7500