Provider Demographics
NPI:1689903494
Name:COOPER, PHILLIP CHARLES
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:CHARLES
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 ARNOLD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4189
Mailing Address - Country:US
Mailing Address - Phone:925-957-5161
Mailing Address - Fax:925-957-5156
Practice Address - Street 1:1340 ARNOLD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4189
Practice Address - Country:US
Practice Address - Phone:925-957-5161
Practice Address - Fax:925-957-5156
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator