Basic Information
| Provider Information | |||||||||
| NPI: | 1215943998 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COE | ||||||||
| FirstName: | DARLENE | ||||||||
| MiddleName: | RENARITA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7424 BRIDGEPORT WAY W | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984998120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535812111 | ||||||||
| FaxNumber: | 2535812712 | ||||||||
| Practice Location | |||||||||
| Address1: | 7424 BRIDGEPORT WAY W | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984998120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535812111 | ||||||||
| FaxNumber: | 2535812712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD00040878 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 187383 | 01 | WA | LABOR & INDUSTRY | OTHER | 8931012 | 01 | WA | CRIME VICTIMS | OTHER | 8297285 | 05 | WA | MEDICAID |