Individual
CHARLES COFFEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 LOS GAMOS DR, SAN RAFAEL, CA 94903-1841
(415) 630-3557
Mailing address
1500 LOS GAMOS DR, SAN RAFAEL, CA 94903-1841
(415) 630-3557
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
08/06/2025
Last updated
08/06/2025
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