Provider Demographics
NPI:1548460892
Name:COHEN, JACOB A
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:A
Last Name:COHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 W 8TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4019
Mailing Address - Country:US
Mailing Address - Phone:213-368-1888
Mailing Address - Fax:213-368-6888
Practice Address - Street 1:2120 W 8TH ST
Practice Address - Street 2:SUIT 210
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4019
Practice Address - Country:US
Practice Address - Phone:213-368-1888
Practice Address - Fax:213-368-6888
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator