Healthcare Provider Details

I. General information

NPI: 1548455777
Provider Name (Legal Business Name): LESTER COOK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 BLOOMFIELD AVE RM 147
NORWALK CA
90650-2015
US

IV. Provider business mailing address

11401 BLOOMFIELD AVE RM 147
NORWALK CA
90650-2015
US

V. Phone/Fax

Practice location:
  • Phone: 562-863-7011
  • Fax:
Mailing address:
  • Phone: 562-863-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA68912
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA68912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: