Provider Demographics
NPI:1861460123
Name:COCKRILL, MIKE (IDC)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:COCKRILL
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 ABALONE CV
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-1546
Mailing Address - Country:US
Mailing Address - Phone:757-575-6336
Mailing Address - Fax:
Practice Address - Street 1:UNDERWATER CONSTRUCTION TEAM 2
Practice Address - Street 2:4643 DOCK ROAD, BLDG 524
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93043-0001
Practice Address - Country:US
Practice Address - Phone:805-982-2464
Practice Address - Fax:805-982-3246
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman