Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 6051 | AZ |
NPI | 1508060047 |
---|---|
Provider Name | Dr. Alisa Joy Cooper |
First Address | Scottsdale, AZ 85259-4618 |
Second Address | Scottsdale, AZ 85259-4618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 08/07/2007 |