Healthcare Provider Details

I. General information

NPI: 1003147455
Provider Name (Legal Business Name): REBECKA LYNN COOPERMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11230 SORRENTO VALLEY RD SUITE 120
SAN DIEGO CA
92121-1332
US

IV. Provider business mailing address

11230 SORRENTO VALLEY RD SUITE 120
SAN DIEGO CA
92121-1332
US

V. Phone/Fax

Practice location:
  • Phone: 858-546-7600
  • Fax: 858-408-4281
Mailing address:
  • Phone: 858-546-7600
  • Fax: 858-408-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number574398
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number20878
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number3619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: