Provider Demographics
NPI:1396593901
Name:COOPER, DOMINIQUE SHAREE
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:SHAREE
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 APACHE ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-1803
Mailing Address - Country:US
Mailing Address - Phone:510-994-1322
Mailing Address - Fax:510-994-1322
Practice Address - Street 1:1184 APACHE ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-1803
Practice Address - Country:US
Practice Address - Phone:510-994-1322
Practice Address - Fax:510-994-1322
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician