Provider Demographics
NPI:1679696660
Name:ANTONIO K COIRIN M.D. INC.
Entity Type:Organization
Organization Name:ANTONIO K COIRIN M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:K
Authorized Official - Last Name:COIRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-300-7947
Mailing Address - Street 1:1329 SPANOS CT
Mailing Address - Street 2:SIUTE B4
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2806
Mailing Address - Country:US
Mailing Address - Phone:209-300-7947
Mailing Address - Fax:209-566-9079
Practice Address - Street 1:1329 SPANOS CT
Practice Address - Street 2:SIUTE B4
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2806
Practice Address - Country:US
Practice Address - Phone:209-300-7947
Practice Address - Fax:209-566-9079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG596970174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE50794Medicare UPIN
CAG596970Medicare ID - Type Unspecified