Provider Demographics
NPI:1932359841
Name:IV, RATHAPHIROM COCO (DC)
Entity Type:Individual
Prefix:DR
First Name:RATHAPHIROM
Middle Name:COCO
Last Name:IV
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:COCO
Other - Middle Name:
Other - Last Name:IV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2111 CRESCENT OAK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4019
Mailing Address - Country:US
Mailing Address - Phone:310-740-7485
Mailing Address - Fax:949-654-9712
Practice Address - Street 1:3127 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2507
Practice Address - Country:US
Practice Address - Phone:310-453-9004
Practice Address - Fax:310-453-9014
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-27
Last Update Date:2008-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27449111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation