Healthcare Provider Details

I. General information

NPI: 1689020786
Provider Name (Legal Business Name): ANNA VENECIA KOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 STONERIDGE DR
PLEASANTON CA
94588-4501
US

IV. Provider business mailing address

2136 SE ANKENY ST APT. 2
PORTLAND OR
97214-1670
US

V. Phone/Fax

Practice location:
  • Phone: 925-847-5100
  • Fax:
Mailing address:
  • Phone: 310-343-9872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: