Healthcare Provider Details

I. General information

NPI: 1073588786
Provider Name (Legal Business Name): RONALD SCOTT COHEN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3142 VISTA WAY STE. 207
OCEANSIDE CA
92056
US

IV. Provider business mailing address

3142 VISTA WAY STE. 207
OCEANSIDE CA
92056
US

V. Phone/Fax

Practice location:
  • Phone: 760-721-4000
  • Fax: 760-721-4005
Mailing address:
  • Phone: 760-721-4000
  • Fax: 760-721-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA73894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: