Healthcare Provider Details

I. General information

NPI: 1376688374
Provider Name (Legal Business Name): JACQUELINE K KOPPERS PSYD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE KRISTINE KOPPERS

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/15/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 BARRANCA PKWY STE 260
IRVINE CA
92604-4780
US

IV. Provider business mailing address

4040 BARRANCA PKWY STE 260
IRVINE CA
92604-4780
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone: 925-282-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: