Provider Demographics
NPI:1548076995
Name:COHEN, AMIE ALONZO (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:ALONZO
Last Name:COHEN
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 MELVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2903
Mailing Address - Country:US
Mailing Address - Phone:626-840-4601
Mailing Address - Fax:
Practice Address - Street 1:2705 MELVILLE DR
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2903
Practice Address - Country:US
Practice Address - Phone:626-840-4601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032921363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner