Healthcare Provider Details

I. General information

NPI: 1619129954
Provider Name (Legal Business Name): LILIA FERNANDEZ COPPA, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 W GONZALES RD STE 130
OXNARD CA
93036-0721
US

IV. Provider business mailing address

451 W GONZALES RD STE 130
OXNARD CA
93036-0721
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-7691
  • Fax: 805-981-7676
Mailing address:
  • Phone: 805-981-7691
  • Fax: 805-981-7676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG77445
License Number StateCA

VIII. Authorized Official

Name: DR. LILIA FERNANDEZ COPPA
Title or Position: OWNER/DIRECTOR
Credential: M.D.
Phone: 805-302-6156