Provider Demographics
NPI:1245458504
Name:COFFEY, LATRICIA (MD)
Entity type:Individual
Prefix:DR
First Name:LATRICIA
Middle Name:
Last Name:COFFEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 PASEO DEL PRADO
Mailing Address - Street 2:D307
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4360
Mailing Address - Country:US
Mailing Address - Phone:702-748-7749
Mailing Address - Fax:
Practice Address - Street 1:2340 PASEO DEL PRADO
Practice Address - Street 2:D307
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4360
Practice Address - Country:US
Practice Address - Phone:702-748-7749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2013-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0577902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEI25218Medicare UPIN