Provider Demographics
NPI:1720852163
Name:COOK, FERMINA
Entity Type:Individual
Prefix:
First Name:FERMINA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34111 WILDWOOD CANYON RD SPC 40
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2600
Mailing Address - Country:US
Mailing Address - Phone:909-328-0065
Mailing Address - Fax:
Practice Address - Street 1:34111 WILDWOOD CANYON RD SPC 40
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2600
Practice Address - Country:US
Practice Address - Phone:909-328-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker