Healthcare Provider Details

I. General information

NPI: 1780737981
Provider Name (Legal Business Name): JOANNIE MAE CATHEY COOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W VERNON AVE STE 204
LOS ANGELES CA
90037-2700
US

IV. Provider business mailing address

904 SILVER SPUR RD #200
ROLLING HILLS CA
90274
US

V. Phone/Fax

Practice location:
  • Phone: 310-724-7448
  • Fax: 323-232-6784
Mailing address:
  • Phone: 310-724-7448
  • Fax: 323-232-6784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberA33575
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA33575
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberA33575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: