Individual
JIMY ROGER COOK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ENP/FNP
Contact information
Practice address
CAMP PENDLETON NAVAL HOSPITAL, CAMP PENDLETON, CA 92055-5191
(760) 725-1184
Mailing address
33123 TIVOLI ST, TEMECULA, CA 92592-4370
(951) 699-9949
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
650309
TX
Other
Enumeration date
07/21/2006
Last updated
07/08/2007
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