Healthcare Provider Details

I. General information

NPI: 1528154689
Provider Name (Legal Business Name): STEPHEN HART COOPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18399 VENTURA BLVD #248
TARZANA CA
91356
US

IV. Provider business mailing address

18399 VENTURA BLVD #248
TARZANA CA
91356
US

V. Phone/Fax

Practice location:
  • Phone: 818-708-3600
  • Fax: 818-708-1648
Mailing address:
  • Phone: 818-708-3600
  • Fax: 818-708-1648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA23523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: