Healthcare Provider Details

I. General information

NPI: 1861276925
Provider Name (Legal Business Name): COHEN BEAUTY WIGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6509 N 7TH ST
PHOENIX AZ
85014-1203
US

IV. Provider business mailing address

6509 N 7TH ST
PHOENIX AZ
85014-1203
US

V. Phone/Fax

Practice location:
  • Phone: 480-793-0017
  • Fax: 480-452-1117
Mailing address:
  • Phone: 480-793-0017
  • Fax: 480-452-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: MRS. ESTER MIRAKOV COHEN
Title or Position: SPECIALIST
Credential: CRANIAL PROSTHESIS
Phone: 480-793-0017