Healthcare Provider Details

I. General information

NPI: 1831331073
Provider Name (Legal Business Name): SHARIAR COHEN MD CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 SAINT CHARLES DR
THOUSAND OAKS CA
91360-3953
US

IV. Provider business mailing address

566 SAINT CHARLES DR
THOUSAND OAKS CA
91360-3953
US

V. Phone/Fax

Practice location:
  • Phone: 805-449-8781
  • Fax: 805-449-4224
Mailing address:
  • Phone: 805-449-8781
  • Fax: 805-449-4224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA88619
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberA88619
License Number StateCA

VIII. Authorized Official

Name: MR. SHARIAR COHEN-GADOL
Title or Position: PRESIDENT
Credential: M.D
Phone: 310-709-3564