Provider Demographics
NPI:1194883462
Name:COHEN, MELVIN S (MD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:S
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3043 MONTEREY RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1773
Mailing Address - Country:US
Mailing Address - Phone:626-799-1584
Mailing Address - Fax:
Practice Address - Street 1:3043 MONTEREY RD
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1773
Practice Address - Country:US
Practice Address - Phone:626-799-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA28701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A287010Medicaid
CAA28701OtherLICENCE NUMBER
CABC0778071OtherDEA NUMBER
CA00A287010Medicaid