Provider Demographics
NPI:1891775235
Name:COPPELSON, AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:
Last Name:COPPELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ARIO
Other - Middle Name:S
Other - Last Name:FAKHERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 261399
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-1399
Mailing Address - Country:US
Mailing Address - Phone:818-465-6620
Mailing Address - Fax:818-465-6622
Practice Address - Street 1:16530 VENTURA BLVD
Practice Address - Street 2:SUITE 408
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4554
Practice Address - Country:US
Practice Address - Phone:818-465-6620
Practice Address - Fax:818-465-6622
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76120174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA76120Medicaid
CA615579800OtherDEPT. OF LABOR
CAA76120OtherMEDICAL LICENSE
CAA76120OtherMEDICAL LICENSE
CAA76120Medicaid
CAH52050Medicare UPIN