Individual
MR. JASON ROBERT COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., PA-C
Contact information
Practice address
2720 N HARBOR BLVD, SUITE 130, FULLERTON, CA 92835-2609
(714) 449-6200
Mailing address
701 COLUSA DR, WALNUT, CA 91789-4526
(415) 299-2273
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA18459
CA
363AS0400X
Surgical Physician Assistant
Primary
PA18459
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA18459
PA LICENSE NUMBER
CA
Enumeration date
03/01/2007
Last updated
06/28/2023
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