Healthcare Provider Details

I. General information

NPI: 1427237650
Provider Name (Legal Business Name): BARRY M. COGEN, D.O., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2772 JOHNSON DR SUITE 114
VENTURA CA
93003
US

IV. Provider business mailing address

2772 JOHNSON DR SUITE 114
VENTURA CA
93003
US

V. Phone/Fax

Practice location:
  • Phone: 805-644-3311
  • Fax: 805-644-2161
Mailing address:
  • Phone: 805-644-3311
  • Fax: 805-644-2161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A5574
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A5574
License Number StateCA

VIII. Authorized Official

Name: DR. BARRY MATTHEW COGEN
Title or Position: DIRECTOR
Credential: D.O.
Phone: 805-644-3311