Healthcare Provider Details

I. General information

NPI: 1467581314
Provider Name (Legal Business Name): JULIE CATHERINE COOK B.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 SUTTERVILLE RD
SACRAMENTO CA
95820-1024
US

IV. Provider business mailing address

2000 LAKE FRONT DR #523
SACRAMENTO CA
95831-5631
US

V. Phone/Fax

Practice location:
  • Phone: 916-732-2250
  • Fax: 916-454-5031
Mailing address:
  • Phone: 915-732-2250
  • Fax: 916-454-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA6300324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: