Healthcare Provider Details

I. General information

NPI: 1598831505
Provider Name (Legal Business Name): JACQUELINE COPELAND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 N HACIENDA BLVD
LA PUENTE CA
91744-1133
US

IV. Provider business mailing address

1431 N HACIENDA BLVD
LA PUENTE CA
91744-1133
US

V. Phone/Fax

Practice location:
  • Phone: 626-918-3828
  • Fax: 626-918-3538
Mailing address:
  • Phone: 626-918-3828
  • Fax: 626-918-3538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number16187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: