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NPI Code Detail

MEDICARE: RANDALL COPAS

MEDICARE: RANDALL COPAS
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
1101YA0400XAddiction (Substance Use Disorder) CounselorR1242190117CA

General Provider Information

NPI Number : 1821518424
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDALL COPAS
Provider Business Mailing Address
First Line : 225 GRANDVIEW ST
Second Line :
City : PASADENA
State : CA
Zip : 91104-2114
Country : US
Telephone Number : 626-797-1124
Fax Number : 626-398-5984
Provider Business Practice Location Address
First Line : 225 GRANDVIEW ST
Second Line :
City : PASADENA
State : CA
Zip : 91104-2114
Country : US
Telephone Number : 626-797-1124
Fax Number : 626-398-5984
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2017
Last Update Date : 07/21/2022

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1992225726 — ROBERT GARCIA
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Directions to “ RANDALL COPAS ” Practice Location

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