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General NPI Number Information
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NPI Number | 1275792368
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Entity Type | Individual
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Provider Name | JOANNA KOPACZ MD
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Gender | Female
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Dates
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Enumeration Date | 06/04/2008
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 24411 HEALTH CENTER DR STE 560
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3687
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Country | US
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Telephone | 949-218-7251
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 29491
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City | SAINT LOUIS
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State | MO
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Zip | 63126-7491
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Country | US
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Telephone | 949-218-7251
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Fax | 949-209-2669
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 262583
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | A128174
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License Number State | CA
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