Healthcare Provider Details

I. General information

NPI: 1316012966
Provider Name (Legal Business Name): RON W COOPER L.V.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 16TH ST
SAN DIEGO CA
92101-7609
US

IV. Provider business mailing address

531 16TH ST
SAN DIEGO CA
92101-7609
US

V. Phone/Fax

Practice location:
  • Phone: 619-233-3432
  • Fax: 619-233-7022
Mailing address:
  • Phone: 619-233-3432
  • Fax: 619-233-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN166275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: