Provider Demographics
NPI:1386469930
Name:COCKERHAM, RUDOLPH CALVIN (RN)
Entity type:Individual
Prefix:
First Name:RUDOLPH
Middle Name:CALVIN
Last Name:COCKERHAM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5758 W LAS POSITAS BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4083
Mailing Address - Country:US
Mailing Address - Phone:925-596-5978
Mailing Address - Fax:
Practice Address - Street 1:4151 W LAS POSITAS BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4130
Practice Address - Country:US
Practice Address - Phone:925-596-5978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425696163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics