Healthcare Provider Details

I. General information

NPI: 1215621537
Provider Name (Legal Business Name): JOE COOPER MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8436 W 3RD ST STE 800
LOS ANGELES CA
90048-4100
US

IV. Provider business mailing address

8436 W 3RD ST STE 800
LOS ANGELES CA
90048-4100
US

V. Phone/Fax

Practice location:
  • Phone: 310-860-3048
  • Fax: 310-550-7680
Mailing address:
  • Phone: 310-860-3048
  • Fax: 310-550-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH COOPER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 310-860-3048