Provider Demographics
NPI:1831873264
Name:COFFEY, STEPHANIE (MS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:COFFEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 461413
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-9413
Mailing Address - Country:US
Mailing Address - Phone:858-230-1477
Mailing Address - Fax:
Practice Address - Street 1:1545 N ORANGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-2617
Practice Address - Country:US
Practice Address - Phone:858-230-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist