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General NPI Number Information
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NPI Number | 1467304493
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Entity Type | Individual
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Provider Name | BRIAN RICKEY DYLVACHEO COOPER
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Gender | Male
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 349 E WYOMING ST
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City | FAIRFIELD
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State | CA
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Zip | 94533-5205
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Country | US
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Telephone | 707-294-0842
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Fax |
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Provider Business Mailing Address
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Address Line | 349 E WYOMING ST
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City | FAIRFIELD
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State | CA
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Zip | 94533-5205
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Country | US
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Telephone | 707-294-0842
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | W8592729
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License Number State | CA
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