Provider Demographics
NPI:1477560506
Name:COOKE, LAURA GRECI (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:GRECI
Last Name:COOKE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:SCHUM
Other - Last Name:GRECI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:16950 VIA TAZON
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1607
Mailing Address - Country:US
Mailing Address - Phone:619-446-1861
Mailing Address - Fax:619-557-2770
Practice Address - Street 1:16950 VIA TAZON
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1607
Practice Address - Country:US
Practice Address - Phone:619-446-1861
Practice Address - Fax:619-557-2770
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84395207P00000X, 207R00000X, 2083P0901X, 208M00000X
NM2002-0407207P00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H64236Medicare UPIN