Healthcare Provider Details

I. General information

NPI: 1902959612
Provider Name (Legal Business Name): SHERI KOPLIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 CROWN VALLEY PKWY SUITE 250
MISSION VIEJO CA
92691-6384
US

IV. Provider business mailing address

26800 CROWN VALLEY PKWY SUITE 250
MISSION VIEJO CA
92691-6384
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-3570
  • Fax: 949-364-3430
Mailing address:
  • Phone: 949-364-3570
  • Fax: 949-364-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA96659
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA96659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: