Provider Demographics
NPI:1922423201
Name:KOPINGA, ELAINE (CNM)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:KOPINGA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3173 CORTE PORTOFINO
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3266
Mailing Address - Country:US
Mailing Address - Phone:917-573-2600
Mailing Address - Fax:949-548-6201
Practice Address - Street 1:320 SUPERIOR AVE STE 360
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2795
Practice Address - Country:US
Practice Address - Phone:949-548-6200
Practice Address - Fax:949-548-6201
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23690363LW0102X
CA2073367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health