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NPI Code Detail

MEDICARE: ANNINA COOPER MS, GC

MEDICARE: ANNINA COOPER MS, GC
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
1170300000XGenetic Counselor (M.S.)

General Provider Information

NPI Number : 1639780075
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNINA COOPER MS, GC
Provider Business Mailing Address
First Line : 4359 CHARLEMAGNE AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90808-1410
Country : US
Telephone Number : 562-900-5232
Fax Number :
Provider Business Practice Location Address
First Line : 4580 ELECTRONICS PL
Second Line :
City : LOS ANGELES
State : CA
Zip : 90039-1008
Country : US
Telephone Number : 562-900-5232
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2020
Last Update Date : 08/10/2020

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