Provider Demographics
NPI:1245074061
Name:SAMANTHA COHEN, MD, INC.
Entity type:Organization
Organization Name:SAMANTHA COHEN, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DEVELOPMENTAL BEHAVIORAL PED.
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-320-8696
Mailing Address - Street 1:3405 KENYON ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5005
Mailing Address - Country:US
Mailing Address - Phone:619-320-8696
Mailing Address - Fax:626-314-5242
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:626-314-5242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Single Specialty