Provider Demographics
NPI:1003904491
Name:COCA, BEATRIZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEATRIZ
Middle Name:
Last Name:COCA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 E ALTADENA DR
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2004
Mailing Address - Country:US
Mailing Address - Phone:626-296-0423
Mailing Address - Fax:626-296-0423
Practice Address - Street 1:1234 E ALTADENA DR
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-2004
Practice Address - Country:US
Practice Address - Phone:626-840-3241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13099103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP13099Medicare ID - Type Unspecified