Provider Demographics
NPI:1972964716
Name:MEDINA COCKERHAM, MARIA (CNA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MEDINA COCKERHAM
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 SINGING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-6635
Mailing Address - Country:US
Mailing Address - Phone:949-241-9653
Mailing Address - Fax:
Practice Address - Street 1:4925 SINGING HILLS DR
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-6635
Practice Address - Country:US
Practice Address - Phone:949-241-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00879291374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide