Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 20878 | CA |
NPI | 1003147455 |
---|---|
Provider Name | Rebecka Lynn Cooperman |
First Address | San Diego, CA 92121-1332 |
Second Address | San Diego, CA 92121-1332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2010 |
Last Update Date | 03/02/2015 |