Basic Information
| Provider Information | |||||||||
| NPI: | 1326507062 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COULTER | ||||||||
| FirstName: | LIANNE | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21572 OAKBROOK | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926923014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496774993 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 29873 SANTA MARGARITA PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | RANCHO SANTA MARGARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926883626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497090988 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2019 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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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 | 363A00000X | 15736 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.