Provider Demographics
NPI:1649231531
Name:JULIE COPON, DO INC
Entity Type:Organization
Organization Name:JULIE COPON, DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COPON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-848-5240
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18246Medicare PIN
CAG70004Medicare UPIN