Provider Demographics
NPI:1215075155
Name:COOK, TIMOTHY G (AU D)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:G
Last Name:COOK
Suffix:
Gender:M
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 N INDIAN CANYON DR STE E324
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4868
Mailing Address - Country:US
Mailing Address - Phone:760-320-4136
Mailing Address - Fax:760-318-0205
Practice Address - Street 1:1800 N INDIAN CYN DR STE E-324
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-2918
Practice Address - Country:US
Practice Address - Phone:310-829-2118
Practice Address - Fax:310-829-2004
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU330231H00000X
CAHA2106237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU003300Medicaid
CAAU003300Medicaid