Healthcare Provider Details

I. General information

NPI: 1376134650
Provider Name (Legal Business Name): KOPA HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 LAKE ELLENOR DR STE 700C
ORLANDO FL
32809-4618
US

IV. Provider business mailing address

5900 LAKE ELLENOR DR STE 700C
ORLANDO FL
32809-4618
US

V. Phone/Fax

Practice location:
  • Phone: 407-352-2542
  • Fax:
Mailing address:
  • Phone: 407-352-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY L. BIEGASIEWICZ
Title or Position: PRESIDENT
Credential:
Phone: 407-216-0101