Provider Demographics
NPI:1295923597
Name:RICHARD M. COOPER, D.P.M., INC.
Entity type:Organization
Organization Name:RICHARD M. COOPER, D.P.M., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-999-3200
Mailing Address - Street 1:7325 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE #304
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7325 MEDICAL CENTER DR
Practice Address - Street 2:SUITE #304
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1925
Practice Address - Country:US
Practice Address - Phone:818-999-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2879213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE2879OtherSTATE LICENSE
CAW19537Medicare PIN
CAY49570Medicare UPIN