Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A9756 | CA |
NPI | 1003069121 |
---|---|
Provider Name | Jessica C. Cook |
First Address | San Diego, CA 92102-4541 |
Second Address | San Diego, CA 92117-4410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2008 |
Last Update Date | 05/05/2014 |