Healthcare Provider Details

I. General information

NPI: 1225214349
Provider Name (Legal Business Name): ARTHUR KOPP M.D. AND MARINA BUSSEL M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13031 VILLOSA PL APT 424
PLAYA VISTA CA
90094-6503
US

IV. Provider business mailing address

13031 VILLOSA PL APT 424
PLAYA VISTA CA
90094-6503
US

V. Phone/Fax

Practice location:
  • Phone: 310-721-9030
  • Fax: 310-751-6567
Mailing address:
  • Phone: 310-721-9030
  • Fax: 310-751-6567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberA88371
License Number StateCA

VIII. Authorized Official

Name: DR. ARTHUR KOPP
Title or Position: OWNER
Credential:
Phone: 310-721-9030