Healthcare Provider Details

I. General information

NPI: 1366493629
Provider Name (Legal Business Name): KIMBERLY P. COCKERHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY PEELE

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 CAMINO DEL RIO N STE 200
SAN DIEGO CA
92108-1702
US

IV. Provider business mailing address

PO BOX 503148
SAN DIEGO CA
92150-3148
US

V. Phone/Fax

Practice location:
  • Phone: 619-655-3705
  • Fax:
Mailing address:
  • Phone: 650-804-9270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG86885
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License NumberG86885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: