Healthcare Provider Details

I. General information

NPI: 1619394673
Provider Name (Legal Business Name): BRIAN L. COOPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 PECAN AVE
ORANGEVALE CA
95662-4622
US

IV. Provider business mailing address

3840 ROSIN CT
SACRAMENTO CA
95834-1639
US

V. Phone/Fax

Practice location:
  • Phone: 530-753-2256
  • Fax:
Mailing address:
  • Phone: 530-753-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: