Provider Demographics
NPI:1619129954
Name:LILIA FERNANDEZ COPPA, MD, INC.
Entity Type:Organization
Organization Name:LILIA FERNANDEZ COPPA, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIA
Authorized Official - Middle Name:FERNANDEZ
Authorized Official - Last Name:COPPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-302-6156
Mailing Address - Street 1:451 W GONZALES RD STE 130
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0721
Mailing Address - Country:US
Mailing Address - Phone:805-981-7691
Mailing Address - Fax:805-981-7676
Practice Address - Street 1:451 W GONZALES RD STE 130
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0721
Practice Address - Country:US
Practice Address - Phone:805-981-7691
Practice Address - Fax:805-981-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77445208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245277664OtherINDIVIDUAL NPI