Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | A88619 | CA |
NPI | 1013054865 |
---|---|
Provider Name | Dr. Shariar Cohen-Gadol |
First Address | Thousand Oaks, CA 91360-3953 |
Second Address | Thousand Oaks, CA 91360-3953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 12/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A88619 | MEDICAL LICENSE (01) | CA |