Healthcare Provider Details

I. General information

NPI: 1922423201
Provider Name (Legal Business Name): ELAINE KOPINGA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 08/07/2023
Certification Date: 08/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SUPERIOR AVE STE 360
NEWPORT BEACH CA
92663-2795
US

IV. Provider business mailing address

3173 CORTE PORTOFINO
NEWPORT BEACH CA
92660-3266
US

V. Phone/Fax

Practice location:
  • Phone: 949-548-6200
  • Fax: 949-548-6201
Mailing address:
  • Phone: 917-573-2600
  • Fax: 949-548-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number23690
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: