Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | GFE57434 | CA |
NPI | 1134522279 |
---|---|
Provider Name | Albert Cooper JR. |
First Address | Brea, CA 92821 |
Second Address | Brea, CA 92821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2014 |
Last Update Date | 03/10/2014 |