Provider Demographics
NPI:1700897626
Name:COHEN, TRUDY (NP (ADULT NURSE PRAC)
Entity Type:Individual
Prefix:MS
First Name:TRUDY
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:NP (ADULT NURSE PRAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 VALE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5218
Mailing Address - Country:US
Mailing Address - Phone:760-631-5000
Mailing Address - Fax:760-414-3713
Practice Address - Street 1:1000 VALE TERRACE
Practice Address - Street 2:VISTA COMMUNITY CLINIC
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084
Practice Address - Country:US
Practice Address - Phone:760-631-5000
Practice Address - Fax:760-414-3713
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA704284/NP 17272363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000104000Medicaid
MD006486R01Medicare ID - Type Unspecified
MDP25268Medicare UPIN