Basic Information
Provider Information
NPI: 1386748762
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COHEN
FirstName: SETH
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10333 EL CAMINO REAL
Address2:  
City: ATASCADERO
State: CA
PostalCode: 934225808
CountryCode: US
TelephoneNumber: 8054682000
FaxNumber: 8054682918
Practice Location
Address1: 10333 EL CAMINO REAL
Address2:  
City: ATASCADERO
State: CA
PostalCode: 934225808
CountryCode: US
TelephoneNumber: 8054682000
FaxNumber: 8054682918
Other Information
ProviderEnumerationDate: 09/07/2006
LastUpdateDate: 12/08/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084F0202X47847CAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry

No ID Information.


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