Provider Demographics
NPI:1053545467
Name:COCCO CLINIQUE MD, PA
Entity type:Organization
Organization Name:COCCO CLINIQUE MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNYFER
Authorized Official - Middle Name:FARIDY
Authorized Official - Last Name:COCCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-200-1718
Mailing Address - Street 1:6020 W PLANO PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4640
Mailing Address - Country:US
Mailing Address - Phone:972-200-1817
Mailing Address - Fax:214-432-1806
Practice Address - Street 1:6020 W PLANO PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4640
Practice Address - Country:US
Practice Address - Phone:972-200-1718
Practice Address - Fax:214-432-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty