Basic Information
| Provider Information | |||||||||
| NPI: | 1477560506 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOKE | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | GRECI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, MPH | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GRECI | ||||||||
| OtherFirstName: | LAURA | ||||||||
| OtherMiddleName: | SCHUM | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD, MPH | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 16950 VIA TAZON | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921271607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194461861 | ||||||||
| FaxNumber: | 6195572770 | ||||||||
| Practice Location | |||||||||
| Address1: | 16950 VIA TAZON | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921271607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194461861 | ||||||||
| FaxNumber: | 6195572770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 01/03/2017 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | A84395 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 2002-0407 | NM | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | A84395 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 2083P0901X | A84395 | CA | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine | 208M00000X | A84395 | CA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 2002-0407 | NM | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.