MEDICARE: BRANDY COONTZ

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1720922495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDY COONTZ

Provider Business Mailing Address
First Line	:	669 W 34TH ST STE 102M
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0411
Country	:	US
Telephone Number	:	213-821-5977
Fax Number	:

Provider Business Practice Location Address
First Line	:	669 W 34TH ST STE 102M
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0411
Country	:	US
Telephone Number	:	213-821-5977
Fax Number	:

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

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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Directions to “ BRANDY COONTZ ” Practice Location

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