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NPI Code Detail

MEDICARE: EMMA LUISA LORAYNE COPPOLA

MEDICARE: EMMA LUISA LORAYNE COPPOLA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1245067156
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMA LUISA LORAYNE COPPOLA
Provider Business Mailing Address
First Line : 7132 PORTLAND AVE
Second Line :
City : RICHFIELD
State : MN
Zip : 55423-3264
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7132 PORTLAND AVE
Second Line :
City : RICHFIELD
State : MN
Zip : 55423-3264
Country : US
Telephone Number : 651-217-3637
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2024
Last Update Date : 09/16/2024

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Directions to “ EMMA LUISA LORAYNE COPPOLA ” Practice Location

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