Healthcare Provider Details

I. General information

NPI: 1144044512
Provider Name (Legal Business Name): COORDINATED OPTIMUM HEALTH WITH OUTSTANDING PROVIDERS-COHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 S BUDLONG AVE
LOS ANGELES CA
90044-2736
US

IV. Provider business mailing address

6060 S BUDLONG AVE
LOS ANGELES CA
90044-2736
US

V. Phone/Fax

Practice location:
  • Phone: 310-872-8408
  • Fax:
Mailing address:
  • Phone: 310-872-8408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. REMY BLACK
Title or Position: CEO
Credential: DDS, MBA
Phone: 310-872-8408