Provider Demographics
NPI:1831227610
Name:COOK, JASON ROBERT (MS, PA-C)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ROBERT
Last Name:COOK
Suffix:
Gender:M
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 COLUSA DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4526
Mailing Address - Country:US
Mailing Address - Phone:415-299-2273
Mailing Address - Fax:
Practice Address - Street 1:2720 N HARBOR BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2609
Practice Address - Country:US
Practice Address - Phone:714-449-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18459363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA18459OtherPA LICENSE NUMBER