MEDICARE: DR. ALEX JAVIER KOPELOWICZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	G66500	CA

General Provider Information

NPI Number	:	1033291950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEX JAVIER KOPELOWICZ M.D.

Provider Business Mailing Address
First Line	:	2991 TIFFANY CIR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-1720
Country	:	US
Telephone Number	:	818-832-2400
Fax Number	:	818-832-2567

Provider Business Practice Location Address
First Line	:	10605 BALBOA BLVD
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-6342
Country	:	US
Telephone Number	:	818-832-2586
Fax Number	:	818-832-2567

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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