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General NPI Number Information
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NPI Number | 1124837828
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Entity Type | Organization
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Legal Business Name | COACHCARE MSO LLC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 1246 19TH ST
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-3308
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Country | US
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Telephone | 917-324-9942
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Fax |
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Provider Business Mailing Address
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Address Line | 211 E 43RD ST FL 7250
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City | NEW YORK
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State | NY
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Zip | 10017-4707
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP STRATEGY
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Name | LISA LORELLA
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Credential |
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Telephone | 917-336-1205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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