Provider Demographics
NPI:1487992921
Name:COOC, SAM
Entity type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:COOC
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:COOC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2095
Mailing Address - Street 2:ELK GROVE
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95759-2095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 CALIFORNIA DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95696
Practice Address - Country:US
Practice Address - Phone:707-449-6504
Practice Address - Fax:707-453-7047
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical