Provider Demographics
NPI:1316012966
Name:COOPER, RON W (LVN)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:W
Last Name:COOPER
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7609
Mailing Address - Country:US
Mailing Address - Phone:619-233-3432
Mailing Address - Fax:619-233-7022
Practice Address - Street 1:531 16TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7609
Practice Address - Country:US
Practice Address - Phone:619-233-3432
Practice Address - Fax:619-233-7022
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN166275164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse