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General NPI Number Information
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NPI Number | 1851970479
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Entity Type | Individual
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Provider Name | JENNA COOPER
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Gender | Female
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 7986 DAGGET ST
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City | SAN DIEGO
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State | CA
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Zip | 92111-2321
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Country | US
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Telephone | 858-300-0460
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Fax |
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Provider Business Mailing Address
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Address Line | 8765 AERO DR STE 310A
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City | SAN DIEGO
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State | CA
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Zip | 92123-1750
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Country | US
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Telephone | 619-207-0396
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Fax | 858-496-7719
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 109521
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License Number State | CA
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