Provider Demographics
NPI:1508978081
Name:COOPER, JOANNA MARGARET (MPH RD CDE)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:MARGARET
Last Name:COOPER
Suffix:
Gender:F
Credentials:MPH RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 POSADA LN STE C
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-4055
Mailing Address - Country:US
Mailing Address - Phone:805-434-1166
Mailing Address - Fax:805-434-3279
Practice Address - Street 1:295 POSADA LN STE C
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4055
Practice Address - Country:US
Practice Address - Phone:805-434-1166
Practice Address - Fax:805-434-3279
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT14369Medicare UPIN
MNT14369Medicare PIN