Provider Demographics
NPI:1639809361
Name:OCCHINO, CODY DOUGLAS
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:DOUGLAS
Last Name:OCCHINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1588 CASA REAL LN
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2218
Mailing Address - Country:US
Mailing Address - Phone:760-402-7660
Mailing Address - Fax:
Practice Address - Street 1:1588 CASA REAL LN
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2218
Practice Address - Country:US
Practice Address - Phone:760-402-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist