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General NPI Number Information
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NPI Number | 1669491676
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Entity Type | Individual
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Provider Name | GARY P. COPPA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 12/22/2015
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Provider Practice Location Address
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Address Line | 147 N BRENT ST
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City | VENTURA
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State | CA
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Zip | 93003-2809
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Country | US
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Telephone | 805-652-5011
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Fax |
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Provider Business Mailing Address
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Address Line | 3116 W MARCH LN #200
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City | STOCKTON
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State | CA
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Zip | 95219-2369
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Country | US
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Telephone | 209-473-6555
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G79833
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License Number State | CA
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