Provider Demographics
NPI:1033207915
Name:COHEN, IRA RICHARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:RICHARD
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9901 PARAMOUNT BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3853
Mailing Address - Country:US
Mailing Address - Phone:562-923-0371
Mailing Address - Fax:562-927-7222
Practice Address - Street 1:9901 PARAMOUNT BLVD
Practice Address - Street 2:STE 202
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3853
Practice Address - Country:US
Practice Address - Phone:562-923-0371
Practice Address - Fax:562-927-7222
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2612213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E26120Medicaid
CA0918350001Medicare NSC
CA000E26120Medicaid