Healthcare Provider Details

I. General information

NPI: 1104826213
Provider Name (Legal Business Name): HARTLEY COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 LUCAS AVE STE 101
LOS ANGELES CA
90017-1997
US

IV. Provider business mailing address

15581 WILD PLUM CIR
HUNTINGTON BEACH CA
92647-2954
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-1010
  • Fax:
Mailing address:
  • Phone: 213-977-1010
  • Fax: 213-977-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA31532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: