Healthcare Provider Details

I. General information

NPI: 1730869447
Provider Name (Legal Business Name): MARIA HELENA BUITRAGO COHOON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIELDS AVENUE 219 NORTH HALL
DAVIS CA
95616
US

IV. Provider business mailing address

1 SHIELDS AVENUE 219 NORTH HALL
DAVIS CA
95616
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-0871
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number35938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: