Provider Demographics
NPI:1528817988
Name:COHEN PAZ, SAM (MA, JD)
Entity type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:COHEN PAZ
Suffix:
Gender:M
Credentials:MA, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 481254
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-9749
Mailing Address - Country:US
Mailing Address - Phone:310-916-9626
Mailing Address - Fax:
Practice Address - Street 1:2400 MISSION ST # 208
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1632
Practice Address - Country:US
Practice Address - Phone:626-765-1753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139996106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist