Provider Demographics
NPI:1245674654
Name:COHEN, JUSTINE ZOE (LAC)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:ZOE
Last Name:COHEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ZOE
Other - Middle Name:
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:230 GRAND AVE
Mailing Address - Street 2:STE. 202
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4589
Mailing Address - Country:US
Mailing Address - Phone:510-326-7022
Mailing Address - Fax:
Practice Address - Street 1:230 GRAND AVE
Practice Address - Street 2:STE. 202
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4589
Practice Address - Country:US
Practice Address - Phone:510-326-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC-6945171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist