1124838719 NPI number — MRS. PAIGE VICTORIA COFFEE FNP STUDENT

Table of content: MRS. PAIGE VICTORIA COFFEE FNP STUDENT (NPI 1124838719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124838719 NPI number — MRS. PAIGE VICTORIA COFFEE FNP STUDENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COFFEE
Provider First Name:
PAIGE
Provider Middle Name:
VICTORIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP STUDENT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
PAIGE
Provider Other Middle Name:
V
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124838719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4450 ROSITA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATASCADERO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93422-2845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-382-2739
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2150 MAIN ST STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93428-3022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-927-1673
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/07/2025

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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