Healthcare Provider Details

I. General information

NPI: 1881005817
Provider Name (Legal Business Name): POOJA R CHOPRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CORPORATE PLAZA DR
NEWPORT BEACH CA
92660-7985
US

IV. Provider business mailing address

22 CORPORATE PLAZA DR
NEWPORT BEACH CA
92660-7985
US

V. Phone/Fax

Practice location:
  • Phone: 949-722-7038
  • Fax: 949-630-4900
Mailing address:
  • Phone: 949-722-7038
  • Fax: 949-630-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number49843
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberTP293
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301502094
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number4301502094
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA179659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: