Provider Demographics
NPI:1528017480
Name:TIMOTHY J. COEN, M.D., P.C.
Entity Type:Organization
Organization Name:TIMOTHY J. COEN, M.D., P.C.
Other - Org Name:MISSION FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-451-3500
Mailing Address - Street 1:1434 S MISSION RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-4009
Mailing Address - Country:US
Mailing Address - Phone:760-451-3500
Mailing Address - Fax:760-451-3504
Practice Address - Street 1:1434 S MISSION RD
Practice Address - Street 2:SUITE A
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-4009
Practice Address - Country:US
Practice Address - Phone:760-451-3500
Practice Address - Fax:760-451-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19927Medicare PIN