Provider Demographics
NPI:1427296938
Name:COHEN, SAMUEL MOSES (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:MOSES
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 1:78724 VALLEY VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-2664
Mailing Address - Country:US
Mailing Address - Phone:760-200-5998
Mailing Address - Fax:760-200-5999
Practice Address - Street 1:78724 VALLEY VISTA AVE
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-2664
Practice Address - Country:US
Practice Address - Phone:760-200-5998
Practice Address - Fax:760-200-5999
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12883171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor