1194720474 NPI number — DIANE J COKER P.T.

Table of content: DIANE J COKER P.T. (NPI 1194720474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194720474 NPI number — DIANE J COKER P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COKER
Provider First Name:
DIANE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COKER
Provider Other First Name:
DIANE
Provider Other Middle Name:
AUTREY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1194720474
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31063
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAGUNA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92654-1063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-586-3200
Provider Business Mailing Address Fax Number:
949-900-2136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24331 EL TORO RD
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
LAGUNA WOODS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92637-2753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-586-3200
Provider Business Practice Location Address Fax Number:
949-900-2136
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  PT08251 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9105000224 . This is a "CERTIFIED HAND THERAPIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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