Provider Demographics
NPI:1093823221
Name:ROOK, RONALD (PHD)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:ROOK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 NIBLICK LANE
Mailing Address - Street 2:
Mailing Address - City:COTO DE CAZA
Mailing Address - State:CA
Mailing Address - Zip Code:92679-4950
Mailing Address - Country:US
Mailing Address - Phone:949-459-6763
Mailing Address - Fax:
Practice Address - Street 1:1350 E DEVONSHIRE AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-8629
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:800-819-1655
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9906103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL99060OtherBCBS
CAPSY099060Medicaid
CAPSY099060Medicaid