Healthcare Provider Details

I. General information

NPI: 1962326454
Provider Name (Legal Business Name): JAZZMYN DAWN COOLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10755 APPLE VALLEY RD
APPLE VALLEY CA
92308-3684
US

IV. Provider business mailing address

14527 AGAVE WAY
ADELANTO CA
92301-3615
US

V. Phone/Fax

Practice location:
  • Phone: 760-247-9840
  • Fax:
Mailing address:
  • Phone: 760-247-9840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: