Provider Demographics
NPI:1700297439
Name:COCHRANE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:COCHRANE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMANUEL-COCHRANE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:619-575-8887
Mailing Address - Street 1:667 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-1243
Mailing Address - Country:US
Mailing Address - Phone:619-575-8887
Mailing Address - Fax:619-575-1374
Practice Address - Street 1:667 PALM AVE
Practice Address - Street 2:
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-1243
Practice Address - Country:US
Practice Address - Phone:619-575-8887
Practice Address - Fax:619-575-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty