Healthcare Provider Details

I. General information

NPI: 1316237498
Provider Name (Legal Business Name): LYLE COOK PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44374 PALM ST
INDIO CA
92201-3117
US

IV. Provider business mailing address

PO BOX 6789
CHICO CA
95927-6789
US

V. Phone/Fax

Practice location:
  • Phone: 760-342-6616
  • Fax: 760-347-8276
Mailing address:
  • Phone: 530-892-2300
  • Fax: 530-894-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21576
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: