Provider Demographics
NPI:1750568358
Name:PATRICIA COGHLAN, MD
Entity type:Organization
Organization Name:PATRICIA COGHLAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-482-7342
Mailing Address - Street 1:1127 WILSHIRE BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3905
Mailing Address - Country:US
Mailing Address - Phone:213-481-2083
Mailing Address - Fax:213-482-5613
Practice Address - Street 1:1127 WILSHIRE BLVD STE 403
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3905
Practice Address - Country:US
Practice Address - Phone:213-481-2083
Practice Address - Fax:213-482-5613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22797207N00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003917667OtherNPI
1003917667OtherNPI
CAW5187Medicare PIN