Healthcare Provider Details

I. General information

NPI: 1235175456
Provider Name (Legal Business Name): JENNIFER P COHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N ASH ST
ESCONDIDO CA
92027-3058
US

IV. Provider business mailing address

4836 VISTA ST
SAN DIEGO CA
92116-2348
US

V. Phone/Fax

Practice location:
  • Phone: 760-385-3739
  • Fax: 888-800-8266
Mailing address:
  • Phone: 858-822-8773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number38040
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number38040
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA89428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: