Provider Demographics
NPI:1598977407
Name:COOPER, ODELIA (MD)
Entity type:Individual
Prefix:DR
First Name:ODELIA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 BEVERLY BLVD
Mailing Address - Street 2:B-131
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1804
Mailing Address - Country:US
Mailing Address - Phone:310-423-4774
Mailing Address - Fax:310-423-0440
Practice Address - Street 1:8723 ALDEN DR.
Practice Address - Street 2:SSB-290
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-3870
Practice Address - Fax:310-423-0429
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88399207RE0101X, 207RH0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist