=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093823221
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD ROOK PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2006
-----------------------------------------------------
Last Update Date | 06/05/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1350 E DEVONSHIRE AVE
-----------------------------------------------------
City | HEMET
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92544-8629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-257-8715
-----------------------------------------------------
Fax | 800-819-1655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 NIBLICK LANE
-----------------------------------------------------
City | COTO DE CAZA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92679-4950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-459-6763
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY9906
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------