Provider Demographics
NPI:1194832600
Name:ANDREW M COOPERMAN MD
Entity Type:Organization
Organization Name:ANDREW M COOPERMAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOPERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-726-5800
Mailing Address - Street 1:2023 W VISTA WAY STE B
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083
Mailing Address - Country:US
Mailing Address - Phone:760-726-5800
Mailing Address - Fax:760-726-5942
Practice Address - Street 1:2023 W VISTA WAY STE B
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083
Practice Address - Country:US
Practice Address - Phone:760-726-5800
Practice Address - Fax:760-726-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65664207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G656641Medicaid
W18351Medicare ID - Type Unspecified
0204610001Medicare NSC
A78824Medicare UPIN