1346225356 NPI number — DR. MANSOUR JOSHUA COHEN MD

Table of content: DR. MANSOUR JOSHUA COHEN MD (NPI 1346225356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346225356 NPI number — DR. MANSOUR JOSHUA COHEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COHEN
Provider First Name:
MANSOUR
Provider Middle Name:
JOSHUA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COHEN
Provider Other First Name:
JOSHUA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1346225356
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8508 RUETTE MONTE CARLO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA JOLLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92037-2012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-459-0500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7695 CARDINAL CT
Provider Second Line Business Practice Location Address:
SUITE 390
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-3357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-279-8111
Provider Business Practice Location Address Fax Number:
858-279-4703
Provider Enumeration Date:
12/13/2005

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: 174400000X , with the licence number:  A34624 , 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: 00A346240 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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