Healthcare Provider Details

I. General information

NPI: 1154575462
Provider Name (Legal Business Name): DAVID JOSEPH COPENHAVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAVID JOSEPH ALVAVADO-COPENHAVER

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V STREET, SUITE 1220 PSSB UC DAVIS ANESTHESIOLOGY AND PAIN
SACRAMENTO CA
95817
US

IV. Provider business mailing address

4150 V STREET, SUITE 1200 PSSB
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5042
  • Fax: 916-734-2975
Mailing address:
  • Phone: 212-305-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA107352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: