Organization
MATTHEW D COOPER A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAUNTAY CROSS (BILLING ADMINISTRATOR)
(951) 527-5660
Entity
Organization
Contact information
Practice address
1084 N EL CAMINO REAL STE B385, ENCINITAS, CA 92024-1334
(619) 997-8425
Mailing address
1084 N EL CAMINO REAL STE B385, ENCINITAS, CA 92024-1334
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A133250
MEDICAL LICENSE
CA
Enumeration date
02/06/2023
Last updated
02/08/2023
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