Provider Demographics
NPI:1508993593
Name:KOGON, MANUELA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUELA
Middle Name:M
Last Name:KOGON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1416
Mailing Address - Country:US
Mailing Address - Phone:650-498-5566
Mailing Address - Fax:
Practice Address - Street 1:211 QUARRY RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1416
Practice Address - Country:US
Practice Address - Phone:650-498-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA769022084P0800X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
090399OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
090399OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER