Healthcare Provider Details

I. General information

NPI: 1265341598
Provider Name (Legal Business Name): HARONE SANGCOPAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2437 FENTON ST STE B
CHULA VISTA CA
91914-3517
US

IV. Provider business mailing address

6991 PARADISE VALLEY RD APT 121
SAN DIEGO CA
92139-4303
US

V. Phone/Fax

Practice location:
  • Phone: 619-656-5176
  • Fax:
Mailing address:
  • Phone: 619-944-5548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number55137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: