Healthcare Provider Details

I. General information

NPI: 1902875842
Provider Name (Legal Business Name): RICHARD BENSON COOLMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 S BASCOM AVE CENTER FOR LEARNING AND ACHIEMENT
SAN JOSE CA
95128-2651
US

IV. Provider business mailing address

751 S BASCOM AVE
SAN JOSE CA
95128-2604
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5000
  • Fax:
Mailing address:
  • Phone: 408-885-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC37651
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberC37651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: