Healthcare Provider Details

I. General information

NPI: 1831794023
Provider Name (Legal Business Name): CHRISTINA COPPEDGE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA BRAUNWORTH

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27710 JEFFERSON AVE STE 200
TEMECULA CA
92590-4604
US

IV. Provider business mailing address

3397 DORCHESTER DR
SAN DIEGO CA
92123-2609
US

V. Phone/Fax

Practice location:
  • Phone: 951-394-0959
  • Fax:
Mailing address:
  • Phone: 561-236-8212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95016478
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11010341
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: