Healthcare Provider Details

I. General information

NPI: 1558012344
Provider Name (Legal Business Name): AMI BEE COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 CITRUS CIR STE 240
WALNUT CREEK CA
94598-2691
US

IV. Provider business mailing address

1229 1/2 ROSE ST
CROCKETT CA
94525-1362
US

V. Phone/Fax

Practice location:
  • Phone: 510-592-4455
  • Fax:
Mailing address:
  • Phone: 510-681-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number106805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: