Healthcare Provider Details

I. General information

NPI: 1184675324
Provider Name (Legal Business Name): KRISTIN AAMODT KOPELSON MS, RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD CARDIOLOGY, 111E
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

1681 COMSTOCK AVE
LOS ANGELES CA
90024-5300
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax: 310-268-4288
Mailing address:
  • Phone: 310-478-3711
  • Fax: 310-268-4288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number467124/8430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: