Provider Demographics
NPI:1619769320
Name:MACGREGOR, COOPER RAY
Entity type:Individual
Prefix:
First Name:COOPER
Middle Name:RAY
Last Name:MACGREGOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2858 WESTWOOD LN APT 3
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6824
Mailing Address - Country:US
Mailing Address - Phone:203-415-3214
Mailing Address - Fax:
Practice Address - Street 1:2858 WESTWOOD LN APT 3
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6824
Practice Address - Country:US
Practice Address - Phone:203-415-3214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE183304146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic