Healthcare Provider Details

I. General information

NPI: 1811916695
Provider Name (Legal Business Name): BRET COHEN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 S LASKY DR STE 3
BEVERLY HILLS CA
90212-1721
US

IV. Provider business mailing address

5405 AURA AVE
TARZANA CA
91356-3003
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-4477
  • Fax:
Mailing address:
  • Phone: 818-943-0651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA13907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: