Provider Demographics
NPI:1700936168
Name:COKELY, HARRIET TIFFANY (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRIET
Middle Name:TIFFANY
Last Name:COKELY
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 1:2222 SANTA MONICA BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2308
Mailing Address - Country:US
Mailing Address - Phone:310-828-5900
Mailing Address - Fax:310-453-4060
Practice Address - Street 1:2222 SANTA MONICA BLVD STE 402
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2308
Practice Address - Country:US
Practice Address - Phone:310-828-5900
Practice Address - Fax:310-453-4060
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG235302084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G235300Medicaid
CAG23530Medicare PIN
CA00G235300Medicaid
CAB51006Medicare UPIN