Basic Information
| Provider Information | |||||||||
| NPI: | 1356731665 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CODA | ||||||||
| FirstName: | CLARE | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5767 W CENTURY BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900455631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103018771 | ||||||||
| FaxNumber: | 3103018751 | ||||||||
| Practice Location | |||||||||
| Address1: | 9675 BRIGHTON WAY STE 100 | ||||||||
| Address2: | |||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902105132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102057310 | ||||||||
| FaxNumber: | 3102057319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2015 | ||||||||
| LastUpdateDate: | 10/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0087053 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | A165616 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | A165616 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.