Healthcare Provider Details

I. General information

NPI: 1205363264
Provider Name (Legal Business Name): TRAVIS JAMES COHOON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2017
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 ALTON PKWY
IRVINE CA
92618-3734
US

IV. Provider business mailing address

6650 ALTON PKWY
IRVINE CA
92618-3734
US

V. Phone/Fax

Practice location:
  • Phone: 888-988-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA162000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: