Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1063015824 |
---|---|
Provider Name | Jordyn Marie Cochran |
First Address | San Bernardino, CA 92404-5416 |
Second Address | San Bernardino, CA 92404-5416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2020 |
Last Update Date | 16/11/2020 |