Provider Demographics
NPI:1376599159
Name:COATS, MELVIN W (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:W
Last Name:COATS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12900 PARK PLAZA DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:562-622-2800
Mailing Address - Fax:562-741-4479
Practice Address - Street 1:9209 COLIMA RD STE 1000
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1813
Practice Address - Country:US
Practice Address - Phone:562-236-2290
Practice Address - Fax:562-696-1104
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
503010OtherHEALTH NET ID #
P0092759OtherRAILROAD
CA00G668830Medicaid
P00361828OtherRAILROAD
00G668830OtherBLUE SHIELD ID #
CA00G668830Medicaid
CAWG66883FMedicare PIN
00G668830OtherBLUE SHIELD ID #