Provider Demographics
NPI:1629551056
Name:LE COZE, JOHN-LUC MAURICE
Entity Type:Individual
Prefix:
First Name:JOHN-LUC
Middle Name:MAURICE
Last Name:LE COZE
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 1:35751 GATEWAY DR UNIT I922
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6058
Mailing Address - Country:US
Mailing Address - Phone:510-363-2589
Mailing Address - Fax:
Practice Address - Street 1:82900 AVENUE 42
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-9658
Practice Address - Country:US
Practice Address - Phone:760-347-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist