Healthcare Provider Details

I. General information

NPI: 1104182047
Provider Name (Legal Business Name): BETH N CHOPRA RN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 EUREKA SQ
PACIFICA CA
94044-2652
US

IV. Provider business mailing address

1381 WOODLAND AVE
MENLO PARK CA
94025-2849
US

V. Phone/Fax

Practice location:
  • Phone: 650-359-1675
  • Fax:
Mailing address:
  • Phone: 415-572-5571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number21177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: