Provider Demographics
NPI:1922644970
Name:COETZEE, LORNA MARINA (CARETAKER)
Entity type:Individual
Prefix:MS
First Name:LORNA
Middle Name:MARINA
Last Name:COETZEE
Suffix:
Gender:F
Credentials:CARETAKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 MCLELLAN RD
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9512
Mailing Address - Country:US
Mailing Address - Phone:831-706-7166
Mailing Address - Fax:
Practice Address - Street 1:1591 MCLELLAN RD
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9512
Practice Address - Country:US
Practice Address - Phone:831-706-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747A0650X
CA19226449703747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1922644970OtherPALO ALTO HEALTH CARE SERVICES