Healthcare Provider Details

I. General information

NPI: 1174763262
Provider Name (Legal Business Name): MELISSA JILL COHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 SYCAMORE DR 201
SIMI VALLEY CA
93065-1502
US

IV. Provider business mailing address

10945 LECONTE AVE DEPARTMENT OF HEMATOLOGY/ONCONLOGY
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 805-583-0110
  • Fax:
Mailing address:
  • Phone: 310-206-1214
  • Fax: 805-496-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA104517
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA104517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: