Provider Demographics
NPI:1346225356
Name:COHEN, MANSOUR JOSHUA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANSOUR
Middle Name:JOSHUA
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSHUA
Other - Middle Name:
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8508 RUETTE MONTE CARLO
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2012
Mailing Address - Country:US
Mailing Address - Phone:858-459-0500
Mailing Address - Fax:
Practice Address - Street 1:7695 CARDINAL CT
Practice Address - Street 2:SUITE 390
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3357
Practice Address - Country:US
Practice Address - Phone:858-279-8111
Practice Address - Fax:858-279-4703
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34624174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A346240Medicaid
CAA34624Medicare ID - Type Unspecified
CA00A346240Medicaid