Cooperative Labs, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

COOPERATIVE LABS, INC.

Practice address

1421 Edinger Ave Ste D
Tustin, CA 92780-6287

Phone

(657) 232-0363

NPI assigned

Jul 10, 2014

Last updated

Nov 8, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wayne Walz

Title

President

Phone

(657) 232-0835

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541635200000",
    "number": "1467868448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4009",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927814009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 EDINGER AVE STE D",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806287",
            "telephone_number": "657-232-0363"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "999 N Tustin Ave",
            "address_2": "Suite 112",
            "address_purpose": "LOCATION",
            "city": "Santa Ana",
            "state": "CA",
            "postal_code": "927053528",
            "country_code": "US",
            "telephone_number": "651-232-0835",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COOPERATIVE LABS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-10",
        "last_updated": "2018-11-08",
        "status": "A",
        "authorized_official_last_name": "WALZ",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "657-232-0835"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Constandse, MD
• Patricia Contreras
• Hayley Laurynn Cook, ACSW
• Kimberly Nicole Cook, FNP
• Michael D Cooper, DDS
• Mariah Jeanne Corney
• Daniella Gabriella Corona-Garcia, ACSW
• Katia Nicole Correa, PT
• Ernesto Cortes
• Stephanie Cortez, LCSW

• Clinical Medical Laboratory in Tustin, CA
• Providers in Tustin, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.