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NPI Code Detail

MEDICARE: MS. KRYSTAL E COOK M.A.

MEDICARE:  MS. KRYSTAL E COOK  M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1477099844
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KRYSTAL E COOK M.A.
Provider Business Mailing Address
First Line : 1227 E OCEAN BLVD
Second Line : APT #311
City : LONG BEACH
State : CA
Zip : 90802-5875
Country : US
Telephone Number : 951-255-8862
Fax Number :
Provider Business Practice Location Address
First Line : 1227 E OCEAN BLVD
Second Line : APT #311
City : LONG BEACH
State : CA
Zip : 90802-5875
Country : US
Telephone Number : 951-255-8862
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2017
Last Update Date : 01/10/2017

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Directions to “ MS. KRYSTAL E COOK M.A.” Practice Location

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