MEDICARE: DR. LATRICIA COFFEY M.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
1	2084P0800X	Psychiatry Physician	057790	GA

General Provider Information

NPI Number	:	1245458504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LATRICIA COFFEY M.D.

Provider Business Mailing Address
First Line	:	2340 PASEO DEL PRADO
Second Line	:	D307
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4360
Country	:	US
Telephone Number	:	702-748-7749
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 PASEO DEL PRADO
Second Line	:	D307
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4360
Country	:	US
Telephone Number	:	702-748-7749
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	02/03/2013

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