Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | A60074 | CA |
Y | 207PE0004X | Emergency Medical Services | A60074 | CA |
NPI | 1073547808 |
---|---|
Provider Name | Dr. Richelle Jody Cooper |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-3075 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 13/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A600740 | (05) | CA |
G85036 | (02) | CA |