Provider Demographics
NPI:1508881012
Name:COHEN, CATREEN (DDS)
Entity Type:Individual
Prefix:
First Name:CATREEN
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9188 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1320
Mailing Address - Country:US
Mailing Address - Phone:310-276-9966
Mailing Address - Fax:310-276-9933
Practice Address - Street 1:9188 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1320
Practice Address - Country:US
Practice Address - Phone:310-276-9966
Practice Address - Fax:310-276-9933
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92886-02Medicaid
CAG92886-03Medicaid
CAG92886-01Medicaid