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NPI Code Detail

MEDICARE: DR. LAUREL GRAY COMAN PH.D.

MEDICARE: DR. LAUREL GRAY COMAN PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPSY 14722CA

General Provider Information

NPI Number : 1194812016
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAUREL GRAY COMAN PH.D.
Provider Business Mailing Address
First Line : 10182 INDIANA AVE
Second Line : TYLER VILLAGE WELLNESS & RECOVERY CLINIC
City : RIVERSIDE
State : CA
Zip : 92503-5304
Country : US
Telephone Number : 951-509-2400
Fax Number : 951-509-2405
Provider Business Practice Location Address
First Line : 10182 INDIANA AVE
Second Line : TYLER VILLAGE WELLNESS & RECOVERY CLINIC
City : RIVERSIDE
State : CA
Zip : 92503-5304
Country : US
Telephone Number : 951-509-2400
Fax Number : 951-509-2405
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 03/23/2012

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