Healthcare Provider Details

I. General information

NPI: 1215947734
Provider Name (Legal Business Name): BERNARD N COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55585 29 PALMS HWY
YUCCA VALLEY CA
92284-2505
US

IV. Provider business mailing address

55585 29 PALMS HWY
YUCCA VALLEY CA
92284-2505
US

V. Phone/Fax

Practice location:
  • Phone: 760-228-3366
  • Fax: 760-228-3369
Mailing address:
  • Phone: 760-228-3366
  • Fax: 760-228-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA25720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: