Healthcare Provider Details

I. General information

NPI: 1477667152
Provider Name (Legal Business Name): PAUL CLIFFORD COPELAND D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 BURROWS AVE
WEST SACRAMENTO CA
95691-9775
US

IV. Provider business mailing address

PO BOX 981612
WEST SACRAMENTO CA
95798-1612
US

V. Phone/Fax

Practice location:
  • Phone: 916-376-8416
  • Fax: 916-376-0759
Mailing address:
  • Phone: 916-376-8416
  • Fax: 916-376-0759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20A5642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: