Provider Demographics
NPI:1487392346
Name:COOK, SYRENA
Entity type:Individual
Prefix:
First Name:SYRENA
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 1:4660 EL CAJON BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4466
Mailing Address - Country:US
Mailing Address - Phone:619-597-7335
Mailing Address - Fax:619-642-2735
Practice Address - Street 1:4660 EL CAJON BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4466
Practice Address - Country:US
Practice Address - Phone:619-597-7335
Practice Address - Fax:619-642-2735
Is Sole Proprietor?:No
Enumeration Date:2022-05-21
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16260101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)