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General NPI Number Information
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NPI Number | 1982296794
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Entity Type | Individual
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Provider Name | MARGO ELAINE COOPER
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Gender | Female
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 5110 SIERRA RD
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-3237
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Country | US
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Telephone | 909-683-6001
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Fax | 909-614-7999
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Provider Business Mailing Address
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Address Line | 7045 WYNDHAM HILL DR
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City | RIVERSIDE
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State | CA
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Zip | 92506-7505
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Country | US
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Telephone | 909-268-1088
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Fax | 909-614-7999
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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