Healthcare Provider Details

I. General information

NPI: 1265920672
Provider Name (Legal Business Name): ANDREW T COHEN A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 BRIGHTON WAY STE 201
BEVERLY HILLS CA
90210-4709
US

IV. Provider business mailing address

9400 BRIGHTON WAY STE 201
BEVERLY HILLS CA
90210-4709
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-8771
  • Fax: 310-388-5222
Mailing address:
  • Phone: 310-659-8771
  • Fax: 310-388-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA56223
License Number StateCA

VIII. Authorized Official

Name: MS. JILL ORNITZ COHEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 310-659-8771