Provider Demographics
NPI:1710269386
Name:COE, LIZA JIA (NP)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:JIA
Last Name:COE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4900 SUNSET BLVD
Mailing Address - Street 2:UROLOGY DEPARTMENT 2ND FLOOR -STATION C
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027
Mailing Address - Country:US
Mailing Address - Phone:323-783-0487
Mailing Address - Fax:
Practice Address - Street 1:4900 W SUNSET BLVD
Practice Address - Street 2:UROLOGY DEPARTMENT 2ND FLOOR -STATION C
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5814
Practice Address - Country:US
Practice Address - Phone:323-783-0487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20439208000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA200354883Medicaid