Healthcare Provider Details

I. General information

NPI: 1184184251
Provider Name (Legal Business Name): JEFFREY ABRAHM COHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 AERO DR STE 130
SAN DIEGO CA
92123-1767
US

IV. Provider business mailing address

8765 AERO DR STE 130
SAN DIEGO CA
92123-1767
US

V. Phone/Fax

Practice location:
  • Phone: 858-541-0181
  • Fax: 858-637-9035
Mailing address:
  • Phone: 858-541-0181
  • Fax: 760-705-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA185661
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA185661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: