Healthcare Provider Details

I. General information

NPI: 1982128591
Provider Name (Legal Business Name): CORAL NICOLE ROPER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2288 MARKET ST
SAN FRANCISCO CA
94114-1506
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 415-964-4855
  • Fax: 415-965-7940
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07171376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: