Healthcare Provider Details

I. General information

NPI: 1598021982
Provider Name (Legal Business Name): ZACHARY CARL COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5395 RUFFIN RD STE 204
SAN DIEGO CA
92123-1338
US

IV. Provider business mailing address

5395 RUFFIN RD STE 204
SAN DIEGO CA
92123-1338
US

V. Phone/Fax

Practice location:
  • Phone: 858-571-3630
  • Fax: 858-295-3948
Mailing address:
  • Phone: 858-571-3630
  • Fax: 858-295-3948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA146733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: