Provider Demographics
NPI:1083736136
Name:BURAPHACHEEP-COGGINS, WANICHA (MD)
Entity Type:Individual
Prefix:
First Name:WANICHA
Middle Name:
Last Name:BURAPHACHEEP-COGGINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 S PACHECO ST
Mailing Address - Street 2:NM DOH FAMILY PLANNING PROGRAM
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5472
Mailing Address - Country:US
Mailing Address - Phone:505-476-8870
Mailing Address - Fax:505-476-8898
Practice Address - Street 1:2040 S PACHECO ST
Practice Address - Street 2:NM DOH FAMILY PLANNING PROGRAM
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5472
Practice Address - Country:US
Practice Address - Phone:505-476-8870
Practice Address - Fax:505-476-8898
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM98-342080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases