Provider Demographics
NPI:1083840540
Name:COLEMAN, COLE
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 TOWER WAY
Mailing Address - Street 2:110
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1597
Mailing Address - Country:US
Mailing Address - Phone:661-859-2135
Mailing Address - Fax:661-323-1302
Practice Address - Street 1:1001 TOWER WAY
Practice Address - Street 2:110
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1597
Practice Address - Country:US
Practice Address - Phone:661-859-2135
Practice Address - Fax:661-323-1302
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator