Healthcare Provider Details

I. General information

NPI: 1528251675
Provider Name (Legal Business Name): JEFFREY JAY COWAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 TORRANCE BLVD 600
TORRANCE CA
90503-4504
US

IV. Provider business mailing address

4201 TORRANCE BLVD 600
TORRANCE CA
90503-4504
US

V. Phone/Fax

Practice location:
  • Phone: 310-540-5503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberG35295
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY JAY COWAN
Title or Position: PRESIDENT
Credential:
Phone: 310-540-5503