Provider Demographics
NPI:1629272588
Name:COOLEY, SABRINA JANELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:SABRINA
Middle Name:JANELLE
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SABRINA
Other - Middle Name:COOLEY
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:27800 MEDICAL CENTER RD
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6410
Mailing Address - Country:US
Mailing Address - Phone:949-364-3532
Mailing Address - Fax:949-652-7080
Practice Address - Street 1:27800 MEDICAL CENTER RD
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6410
Practice Address - Country:US
Practice Address - Phone:949-364-3532
Practice Address - Fax:949-652-7080
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB215770Medicare PIN