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General NPI Number Information
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NPI Number | 1760623599
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Entity Type | Organization
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Legal Business Name | COLLEEN COPELAN, M.D. INC
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Dates
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Enumeration Date | 03/06/2009
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 970 SOUTH PETIT AVE. SUITE A
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City | VENTURA
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State | CA
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Zip | 93004
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Country | US
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Telephone | 805-659-1333
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Fax | 805-659-1408
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Provider Business Mailing Address
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Address Line | 970 SOUTH PETIT AVE. SUITE A
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City | VENTURA
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State | CA
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Zip | 93004
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Country | US
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Telephone | 805-659-1333
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Fax | 805-659-1408
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Authorized Official
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Title or Position | CEO
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Name | COLLEEN COPELAN
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Credential |
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Telephone | 805-659-1333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G22018
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License Number State | CA
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