Provider Demographics
NPI:1003839879
Name:COOPER, CHAD (PA)
Entity Type:Individual
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First Name:CHAD
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1400 S HARBOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7577
Mailing Address - Country:US
Mailing Address - Phone:714-879-3400
Mailing Address - Fax:714-441-1998
Practice Address - Street 1:1400 S HARBOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-7577
Practice Address - Country:US
Practice Address - Phone:714-879-3400
Practice Address - Fax:714-441-1998
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA17551363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ40908Medicare UPIN