Healthcare Provider Details

I. General information

NPI: 1366389538
Provider Name (Legal Business Name): ELIZABETH COHANIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5632 VAN NUYS BLVD STE 350
VAN NUYS CA
91401-4602
US

IV. Provider business mailing address

5632 VAN NUYS BLVD STE 350
VAN NUYS CA
91401-4602
US

V. Phone/Fax

Practice location:
  • Phone: 818-454-7386
  • Fax:
Mailing address:
  • Phone: 818-454-7386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: