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General NPI Number Information
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NPI Number | 1750568358
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Entity Type | Organization
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Legal Business Name | PATRICIA COGHLAN, MD
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 1127 WILSHIRE BLVD STE 403
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City | LOS ANGELES
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State | CA
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Zip | 90017-3905
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Country | US
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Telephone | 213-481-2083
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Fax | 213-482-5613
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Provider Business Mailing Address
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Address Line | 1127 WILSHIRE BLVD STE 403
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City | LOS ANGELES
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State | CA
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Zip | 90017-3905
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Country | US
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Telephone | 213-481-2083
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Fax | 213-482-5613
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARCIA THOMPSON
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Credential |
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Telephone | 805-482-7342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A22797
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | A22797
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License Number State | CA
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