Provider Demographics
NPI:1215543319
Name:COFFEY, CHIMENE (RDA)
Entity Type:Individual
Prefix:
First Name:CHIMENE
Middle Name:
Last Name:COFFEY
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30973 MOONFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-7952
Mailing Address - Country:US
Mailing Address - Phone:970-646-5294
Mailing Address - Fax:
Practice Address - Street 1:30035 HAUN RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-6805
Practice Address - Country:US
Practice Address - Phone:951-225-3324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA92080126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant