Healthcare Provider Details

I. General information

NPI: 1578008611
Provider Name (Legal Business Name): CONISHA COOPER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 11/06/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 WESTWOOD PLZ STE C8-193
LOS ANGELES CA
90024-5055
US

IV. Provider business mailing address

760 WESTWOOD PLZ STE C8-193
LOS ANGELES CA
90095-1832
US

V. Phone/Fax

Practice location:
  • Phone: 973-856-1304
  • Fax:
Mailing address:
  • Phone: 310-794-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberFC9615999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: