Healthcare Provider Details

I. General information

NPI: 1508993742
Provider Name (Legal Business Name): STEVEN R COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 EXECUTIVE DR STE 200
SAN DIEGO CA
92121-3023
US

IV. Provider business mailing address

4510 EXECUTIVE DR STE 200
SAN DIEGO CA
92121-3023
US

V. Phone/Fax

Practice location:
  • Phone: 858-842-2370
  • Fax: 858-842-2375
Mailing address:
  • Phone: 858-842-2370
  • Fax: 858-842-2375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberG66027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: