Provider Demographics
NPI:1174825731
Name:COHEN, SAMANTHA CLAIRE LEWIS (MD)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:CLAIRE LEWIS
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:CLAIRE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1612 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1608
Mailing Address - Country:US
Mailing Address - Phone:626-825-0927
Mailing Address - Fax:833-449-4157
Practice Address - Street 1:3405 KENYON ST STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5005
Practice Address - Country:US
Practice Address - Phone:619-320-8696
Practice Address - Fax:833-449-4157
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1109872080P0006X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics