Provider Demographics
NPI:1982955183
Name:DANIEL J COOPER
Entity Type:Organization
Organization Name:DANIEL J COOPER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:916-983-2193
Mailing Address - Street 1:1561 CREEKSIDE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3495
Mailing Address - Country:US
Mailing Address - Phone:916-983-2193
Mailing Address - Fax:
Practice Address - Street 1:1561 CREEKSIDE DR STE 150
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3495
Practice Address - Country:US
Practice Address - Phone:916-983-2193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA020A62180207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty