Healthcare Provider Details

I. General information

NPI: 1659253524
Provider Name (Legal Business Name): MARJANI DEJONNEE COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

4310 HUBBARD ST UNIT 510
EMERYVILLE CA
94608-3589
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-4444
  • Fax: 628-206-3142
Mailing address:
  • Phone: 510-379-8862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: