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NPI Code Detail

MEDICARE: MADYSON COOPER

MEDICARE: MADYSON COOPER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1457215931
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADYSON COOPER
Provider Business Mailing Address
First Line : 100 N PACIFIC COAST HWY STE 1400
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-5602
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3111 CAMINO DEL RIO N STE 400
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-5724
Country : US
Telephone Number : 888-922-2843
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2025
Last Update Date : 12/10/2025

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Directions to “ MADYSON COOPER ” Practice Location

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