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Provider Information for 1407964000

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. PHYLLIS COHEN M.D.

Other Name:   PHYLLIS COHEN RICH
Gender: FEMALE

Individual NPI: 1407964000

Calendar   Last Updated:  2019-08-26
  Certification Date: 

Details

Name Value
NPI 1407964000
Enumeration Date 2006-08-25
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 325 DISTEL CIR
LOS ALTOS, CA 94022-1408
United States

Phone: 707-541-7700 | Fax: 707-573-5415
View Map External Link
Primary Practice Address 131 STONY CIR STE 1600
SANTA ROSA, CA 95401
United States

Phone: 707-541-7700 | Fax: 707-573-5415
View Map External Link
Secondary Practice Address 131 STONY CIR STE 1600
SANTA ROSA, CA 95401
United States

Phone: 707-541-7700 | Fax: 707-573-5415
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other STATE MEDICAL LICENSE CA G79750
Other FEDERAL DEA LICENSE CA BC4277263
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207Q00000X - Family Medicine CA 535704