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General NPI Number Information
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NPI Number | 1700297439
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Entity Type | Organization
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Legal Business Name | COCHRANE MEDICAL GROUP, INC
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 667 PALM AVE
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City | IMPERIAL BEACH
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State | CA
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Zip | 91932-1243
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Country | US
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Telephone | 619-575-8887
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Fax | 619-575-1374
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Provider Business Mailing Address
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Address Line | 667 PALM AVE
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City | IMPERIAL BEACH
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State | CA
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Zip | 91932-1243
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Country | US
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Telephone | 619-575-8887
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Fax | 619-575-1374
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOY EMMANUEL-COCHRANE
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Credential | D.O.
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Telephone | 619-575-8887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A6250
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License Number State | CA
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