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NPI Code Detail

MEDICARE: KRISTIANA NICOLE KOKER PPSC

MEDICARE: KRISTIANA NICOLE KOKER PPSC
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
1101YS0200XSchool Counselor220018679CA

General Provider Information

NPI Number : 1639035595
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIANA NICOLE KOKER PPSC
Provider Business Mailing Address
First Line : 1754 S CABANA AVE
Second Line :
City : WEST COVINA
State : CA
Zip : 91790-4501
Country : US
Telephone Number : 323-895-0769
Fax Number :
Provider Business Practice Location Address
First Line : 1515 W MISSION RD
Second Line :
City : ALHAMBRA
State : CA
Zip : 91803-1618
Country : US
Telephone Number : 626-943-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2026
Last Update Date : 01/05/2026

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Directions to “ KRISTIANA NICOLE KOKER PPSC” Practice Location

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