Provider Demographics
NPI:1952117012
Name:COOLEY, BRANDON SCOTT (BA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:SCOTT
Last Name:COOLEY
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SHAFFER RD STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-5763
Mailing Address - Country:US
Mailing Address - Phone:408-460-3463
Mailing Address - Fax:
Practice Address - Street 1:1201 SHAFFER RD STE A
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-5763
Practice Address - Country:US
Practice Address - Phone:408-460-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker