Healthcare Provider Details

I. General information

NPI: 1962425587
Provider Name (Legal Business Name): ROBERT CHARLES COHENOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PLAZA #B200
LOS ANGELES CA
90095
US

IV. Provider business mailing address

FILE #2939
LOS ANGELES CA
90074-2939
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-1195
  • Fax:
Mailing address:
  • Phone: 310-301-8709
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG18955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: