Healthcare Provider Details

I. General information

NPI: 1831283993
Provider Name (Legal Business Name): RANDY E COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72780 COUNTRY CLUB DR STE 203
RANCHO MIRAGE CA
92270-4150
US

IV. Provider business mailing address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3221
US

V. Phone/Fax

Practice location:
  • Phone: 760-834-3593
  • Fax: 760-674-3845
Mailing address:
  • Phone: 760-834-3593
  • Fax: 760-674-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036133411
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA40763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: