Provider Demographics
NPI:1578568564
Name:COPON, JULIE (DO)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:COPON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17822 BEACH BLVD.
Mailing Address - Street 2:225
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7190
Mailing Address - Country:US
Mailing Address - Phone:714-848-5240
Mailing Address - Fax:714-848-5260
Practice Address - Street 1:17822 BEACH BLVD.
Practice Address - Street 2:225
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7190
Practice Address - Country:US
Practice Address - Phone:714-848-5240
Practice Address - Fax:714-848-5260
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG70004Medicare UPIN
CAW18246Medicare ID - Type Unspecified