Provider Demographics
NPI:1982296794
Name:COOPER, MARGO ELAINE
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:ELAINE
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7045 WYNDHAM HILL DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-7505
Mailing Address - Country:US
Mailing Address - Phone:909-268-1088
Mailing Address - Fax:909-614-7999
Practice Address - Street 1:5110 SIERRA RD
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-3237
Practice Address - Country:US
Practice Address - Phone:909-683-6001
Practice Address - Fax:909-614-7999
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)