Healthcare Provider Details

I. General information

NPI: 1689334468
Provider Name (Legal Business Name): ZACHARY C COHEN MD APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
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 Number
License Number State

VIII. Authorized Official

Name: MARC FAVILA
Title or Position: OFFICE COORDINATOR/MANAGER
Credential:
Phone: 619-993-2778