Provider Demographics
NPI:1497887475
Name:EMMANUEL-COCHRANE, JOY (DO)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:
Last Name:EMMANUEL-COCHRANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 FENTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3517
Mailing Address - Country:US
Mailing Address - Phone:619-397-0866
Mailing Address - Fax:619-397-0816
Practice Address - Street 1:2437 FENTON ST STE A
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3517
Practice Address - Country:US
Practice Address - Phone:619-397-0866
Practice Address - Fax:619-397-0816
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20A6250BMedicare PIN