Healthcare Provider Details

I. General information

NPI: 1336278373
Provider Name (Legal Business Name): MARSHA K COHEN MS CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N ROXBURY DR 300
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

20 LIGHTHOUSE ST ST 1
MARINA DEL REY CA
90292
US

V. Phone/Fax

Practice location:
  • Phone: 310-888-8037
  • Fax: 310-278-5765
Mailing address:
  • Phone: 310-888-8037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberN00107
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: