Provider Demographics
NPI:1578838678
Name:JOHN M. COCCO, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JOHN M. COCCO, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COCCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-255-6095
Mailing Address - Street 1:24063 REGENTS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2026
Mailing Address - Country:US
Mailing Address - Phone:661-255-6095
Mailing Address - Fax:
Practice Address - Street 1:24063 REGENTS PARK CIR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2026
Practice Address - Country:US
Practice Address - Phone:661-255-6095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40262207QS1201X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG 18076Medicare PIN
CAA40262Medicare UPIN