Healthcare Provider Details

I. General information

NPI: 1013545342
Provider Name (Legal Business Name): YANET CORA KOPNINA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 S PACHECO ST
SANTA FE NM
87505-6103
US

IV. Provider business mailing address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

V. Phone/Fax

Practice location:
  • Phone: 505-477-2200
  • Fax:
Mailing address:
  • Phone: 505-913-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2023-0346
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: