Healthcare Provider Details

I. General information

NPI: 1689051633
Provider Name (Legal Business Name): CAITLIN COHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E. 31ST STREET, QIC 22134 DEPT OF SURGERY,
OAKLAND CA
94602
US

IV. Provider business mailing address

1411 E. 31ST STREET, QIC 22134 DEPT OF SURGERY,
OAKLAND CA
94602
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4965
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: