1093816423 NPI number — DR. ROBYN GROSSMAN COHEN MD

Table of content: DR. ROBYN GROSSMAN COHEN MD (NPI 1093816423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093816423 NPI number — DR. ROBYN GROSSMAN COHEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COHEN
Provider First Name:
ROBYN
Provider Middle Name:
GROSSMAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GROSSMAN
Provider Other First Name:
ROBYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093816423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9834 GENESEE AVENUE
Provider Second Line Business Mailing Address:
SUITE 315
Provider Business Mailing Address City Name:
LA JOLLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92037-1221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-457-4090
Provider Business Mailing Address Fax Number:
858-457-1543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9834 GENESEE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-1221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-457-4090
Provider Business Practice Location Address Fax Number:
858-457-1543
Provider Enumeration Date:
09/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  G26275 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OOG838030 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180041162 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".