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General NPI Number Information
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NPI Number | 1437813904
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Entity Type | Organization
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Legal Business Name | COKO LLC
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Dates
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Enumeration Date | 10/29/2021
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 15215 S. 48TH ST. SUITE 156
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City | PHOENIX
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State | AZ
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Zip | 85044
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Country | US
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Telephone | 480-420-8306
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Fax | 833-881-9193
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Provider Business Mailing Address
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Address Line | 15215 S. 48TH ST. SUITE 156
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City | PHOENIX
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State | AZ
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Zip | 85044
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Country | US
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Telephone | 480-704-8818
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Fax | 833-881-9193
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Authorized Official
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Title or Position | LEAD BILLER
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Name | MS. JENNIFER ANDRES
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Credential |
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Telephone | 480-500-1248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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