Provider Demographics
NPI:1639780844
Name:COCHRAN, THOMAS (CA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 N LOTUS ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1632
Mailing Address - Country:US
Mailing Address - Phone:714-348-6294
Mailing Address - Fax:
Practice Address - Street 1:1169 N LOTUS ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1632
Practice Address - Country:US
Practice Address - Phone:714-348-6294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32669225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist