Provider Demographics
NPI:1275792368
Name:KOPACZ, JOANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:
Last Name:KOPACZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29491
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-7491
Mailing Address - Country:US
Mailing Address - Phone:949-218-7251
Mailing Address - Fax:949-209-2669
Practice Address - Street 1:24411 HEALTH CENTER DR STE 560
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3687
Practice Address - Country:US
Practice Address - Phone:949-218-7251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262583207RI0200X
CAA128174207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA128174OtherSTATE MEDICAL LICENSE