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General NPI Number Information
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NPI Number | 1083213706
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Entity Type | Individual
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Provider Name | COURTNEY KATHRYN HOPP PA
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Gender | Female
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 4060 FOURTH AVE STE 209
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City | SAN DIEGO
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State | CA
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Zip | 92103-2120
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Country | US
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Telephone | 619-320-4807
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Fax |
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Provider Business Mailing Address
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Address Line | 752 C AVE APT C
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City | CORONADO
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State | CA
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Zip | 92118-2245
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Country | US
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Telephone | 603-732-6962
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA58627
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License Number State | CA
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