Provider Demographics
NPI:1124110481
Name:COOKSEY, HELEN SPERRY (MD)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:SPERRY
Last Name:COOKSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 SCHRADER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-6213
Mailing Address - Country:US
Mailing Address - Phone:323-993-8500
Mailing Address - Fax:323-308-4449
Practice Address - Street 1:1625 SCHRADER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-6213
Practice Address - Country:US
Practice Address - Phone:323-993-8500
Practice Address - Fax:323-308-4449
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47669208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G476690Medicaid
CAG47669OtherBLUE CROSS/SHIELD ID #
CAG47669OtherBLUE CROSS/SHIELD ID #
CA00G476690Medicaid