Healthcare Provider Details

I. General information

NPI: 1629643010
Provider Name (Legal Business Name): DR. DEBORAH ANN COHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 34TH ST
SANTA MONICA CA
90405-3114
US

IV. Provider business mailing address

2607 34TH ST
SANTA MONICA CA
90405-3114
US

V. Phone/Fax

Practice location:
  • Phone: 310-795-3960
  • Fax:
Mailing address:
  • Phone: 310-795-3960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberG49012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: