Provider Demographics
NPI:1720230170
Name:COSPER, CHARLES R JR (NCPT 3)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:R
Last Name:COSPER
Suffix:JR
Gender:M
Credentials:NCPT 3
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Mailing Address - Street 1:27 SAPPORO CT
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-5886
Mailing Address - Country:US
Mailing Address - Phone:707-479-6979
Mailing Address - Fax:707-775-4306
Practice Address - Street 1:815 BUENA VISTA AVE W
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-4108
Practice Address - Country:US
Practice Address - Phone:415-762-3700
Practice Address - Fax:415-865-0119
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2023-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPT26317167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician