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General NPI Number Information
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NPI Number | 1932925831
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Entity Type | Individual
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Provider Name | NICHOLAS MICHAEL COOPER RN
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Gender | Male
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 4309 3RD AVE
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City | SAN DIEGO
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State | CA
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Zip | 92103-1407
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Country | US
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Telephone | 619-876-4502
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Fax |
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Provider Business Mailing Address
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Address Line | 6490 AMBROSIA DR APT 5108
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City | SAN DIEGO
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State | CA
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Zip | 92124-5107
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Country | US
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Telephone | 407-406-7071
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95041195
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95360729
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License Number State | CA
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