MEDICARE: MED FIT CONSULTING, INC.

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
1	2083X0100X	Occupational Medicine Physician	A110724	CA

General Provider Information

NPI Number	:	1831605625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED FIT CONSULTING, INC.

Provider Business Mailing Address
First Line	:	11384 COPPERLEAF LN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-2803
Country	:	US
Telephone Number	:	858-382-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	10425 TIERRASANTA BLVD STE 108
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-2618
Country	:	US
Telephone Number	:	858-382-6200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JERALD COOK
Credential	:	MD
Telephone Number	:	858-382-6200

Provider Enumeration Date	:	12/16/2017
Last Update Date	:	12/16/2017

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