Healthcare Provider Details

I. General information

NPI: 1528211257
Provider Name (Legal Business Name): LANAY COHEN MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2008
Last Update Date: 10/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15112 PROVIDENCE LN
NORTH HILLS CA
91343-3464
US

IV. Provider business mailing address

15112 PROVIDENCE LN
NORTH HILLS CA
91343-3464
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number03674654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: