Provider Demographics
NPI:1215711445
Name:COOPER, TANIA R (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:R
Last Name:COOPER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6726 E PREMIUM ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-4135
Mailing Address - Country:US
Mailing Address - Phone:626-664-3420
Mailing Address - Fax:
Practice Address - Street 1:6726 E PREMIUM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-4135
Practice Address - Country:US
Practice Address - Phone:626-664-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA723597163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant