Provider Demographics
NPI:1073005807
Name:COPPLE, ANGELA DIANE
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DIANE
Last Name:COPPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1609
Mailing Address - Country:US
Mailing Address - Phone:760-921-5860
Mailing Address - Fax:760-921-5886
Practice Address - Street 1:240 N BROADWAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1609
Practice Address - Country:US
Practice Address - Phone:760-921-5860
Practice Address - Fax:760-921-5886
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator