Provider Demographics
NPI:1679250856
Name:ST MARY, COENITA MARIE
Entity Type:Individual
Prefix:
First Name:COENITA
Middle Name:MARIE
Last Name:ST MARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 ROSIN CT STE 110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1698
Mailing Address - Country:US
Mailing Address - Phone:916-441-0226
Mailing Address - Fax:916-441-0286
Practice Address - Street 1:600 BERCUT DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-0131
Practice Address - Country:US
Practice Address - Phone:916-440-1500
Practice Address - Fax:916-440-1514
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator