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NPI Code Detail

MEDICARE: RENISE COOPER

MEDICARE: RENISE 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 : 1689521403
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENISE COOPER
Provider Business Mailing Address
First Line : 4221 WILSHIRE BLVD
Second Line : 300
City : LOS ANGELES
State : CA
Zip : 90010-3512
Country : US
Telephone Number : 888-428-3223
Fax Number : 323-866-1881
Provider Business Practice Location Address
First Line : 2900 ADAMS ST
Second Line : C25
City : RIVERSIDE
State : CA
Zip : 92504-4335
Country : US
Telephone Number : 888-428-3223
Fax Number : 323-866-1881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2026
Last Update Date : 03/11/2026

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Directions to “ RENISE COOPER ” Practice Location

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