Healthcare Provider Details

I. General information

NPI: 1639708449
Provider Name (Legal Business Name): TRICIA LEE COHN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1798 N GAREY AVE
POMONA CA
91767-2918
US

IV. Provider business mailing address

2422 VISTA DR
UPLAND CA
91784-1147
US

V. Phone/Fax

Practice location:
  • Phone: 909-469-9318
  • Fax: 909-630-7320
Mailing address:
  • Phone: 909-660-2746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number458880
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number458880
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number458880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: