Healthcare Provider Details

I. General information

NPI: 1336154707
Provider Name (Legal Business Name): PAUL COHEN AZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N LA CIENEGA BLVD SUITE 107
BEVERLY HILLS CA
90211-2222
US

IV. Provider business mailing address

99 N LA CIENEGA BLVD SUITE 107
BEVERLY HILLS CA
90211-2222
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-4743
  • Fax: 310-659-8797
Mailing address:
  • Phone: 310-652-4743
  • Fax: 310-659-8797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG34941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: