Healthcare Provider Details

I. General information

NPI: 1184418204
Provider Name (Legal Business Name): ANTONIO ALBERTO DIAZ COOPER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5743 CORSA AVE STE 112
WESTLAKE VILLAGE CA
91362-6441
US

IV. Provider business mailing address

5743 CORSA AVE STE 112
WESTLAKE VILLAGE CA
91362-6441
US

V. Phone/Fax

Practice location:
  • Phone: 805-790-5300
  • Fax:
Mailing address:
  • Phone: 805-790-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95034612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: