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General NPI Number Information
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NPI Number | 1346931912
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Entity Type | Individual
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Provider Name | JULIA HERTA IONE COOK
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Gender | Female
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 9580 GREGORY ST
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City | LA MESA
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State | CA
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Zip | 91942-3814
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Country | US
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Telephone | 619-251-4883
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Fax |
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Provider Business Mailing Address
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Address Line | 9580 GREGORY ST
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City | LA MESA
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State | CA
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Zip | 91942-3814
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Country | US
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Telephone | 619-251-4883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 29074
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License Number State | CA
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