Individual
CHARLES COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
4715 VIEWRIDGE AVE STE 230, SAN DIEGO, CA 92123-1680
(800) 257-8715
(800) 819-1655
Mailing address
12220 CULVER BLVD APT 5, LOS ANGELES, CA 90066-6283
(310) 313-9274
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY11387
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PSY113870
—
CA
Enumeration date
09/03/2006
Last updated
07/08/2007
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