Provider Demographics
NPI:1356479232
Name:COKER, RANDY (MHWII)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:COKER
Suffix:
Gender:M
Credentials:MHWII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1744 PRESIDIO CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0760
Mailing Address - Country:US
Mailing Address - Phone:209-383-5071
Mailing Address - Fax:
Practice Address - Street 1:300 E 13TH STREET
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340
Practice Address - Country:US
Practice Address - Phone:209-381-6879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator