Provider Demographics
NPI:1255343976
Name:COCA, JAYASHREE S (MD)
Entity type:Individual
Prefix:
First Name:JAYASHREE
Middle Name:S
Last Name:COCA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W THOUSAND OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4402
Mailing Address - Country:US
Mailing Address - Phone:805-777-3505
Mailing Address - Fax:
Practice Address - Street 1:125 W THOUSAND OAKS BLVD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4402
Practice Address - Country:US
Practice Address - Phone:805-777-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA542442084P0804X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric Hospital
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H 099302Medicare ID - Type Unspecified
G27543Medicare UPIN