Healthcare Provider Details

I. General information

NPI: 1780741967
Provider Name (Legal Business Name): ROGER WILLIAM COGER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 ERRINGER RD SUITE 217
SIMI VALLEY CA
93065-2235
US

IV. Provider business mailing address

2345 ERRINGER ROAD SUITE 217
SIMI VALLEY CA
93065-2252
US

V. Phone/Fax

Practice location:
  • Phone: 805-526-4444
  • Fax: 805-526-4446
Mailing address:
  • Phone: 805-526-4444
  • Fax: 805-526-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY7966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: