Provider Demographics
NPI:1679332241
Name:FERNANDEZ-COOPER, LAJUAN
Entity type:Individual
Prefix:
First Name:LAJUAN
Middle Name:
Last Name:FERNANDEZ-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 1:206 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-4309
Mailing Address - Country:US
Mailing Address - Phone:225-264-6670
Mailing Address - Fax:
Practice Address - Street 1:206 CLINIC DR
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-4309
Practice Address - Country:US
Practice Address - Phone:226-264-6670
Practice Address - Fax:225-264-6671
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator