Provider Demographics
NPI:1144917626
Name:GOCKING, ODECIR ELISHA (NP)
Entity type:Individual
Prefix:
First Name:ODECIR
Middle Name:ELISHA
Last Name:GOCKING
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43419 ALTO DR
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-6638
Mailing Address - Country:US
Mailing Address - Phone:386-503-2216
Mailing Address - Fax:
Practice Address - Street 1:43419 ALTO DR
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-6638
Practice Address - Country:US
Practice Address - Phone:386-503-2216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023201363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology