1215252804 NPI number — MRS. NAOMI COOPER MARTIN MFT

Table of content: (NPI 1417176330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215252804 NPI number — MRS. NAOMI COOPER MARTIN MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
NAOMI
Provider Middle Name:
COOPER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COOPER
Provider Other First Name:
NAOMI
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215252804
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2111 S EL CAMINO REAL STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92054-9000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-717-9405
Provider Business Mailing Address Fax Number:
408-419-1852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2424 WEST VISTA WAY,
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-716-3268
Provider Business Practice Location Address Fax Number:
760-439-1124
Provider Enumeration Date:
04/07/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  48304 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)