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General NPI Number Information
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NPI Number | 1932090941
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Entity Type | Individual
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Provider Name | JOHNMARCO COPPOLA MD
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Gender | Male
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 3850 W FLAGLER ST
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City | MIAMI
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State | FL
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Zip | 33134
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Country | US
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Telephone | 305-774-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 12760 TULUM LOOP
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City | VENICE
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State | FL
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Zip | 34293-6193
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Country | US
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Telephone | 631-559-9125
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Fax | 631-559-9125
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | TRN42220
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License Number State | FL
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