Provider Demographics
NPI:1356952915
Name:COPES, RONNELLE ANANI
Entity type:Individual
Prefix:
First Name:RONNELLE
Middle Name:ANANI
Last Name:COPES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 ALCAZAR ST APT 402
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1003
Mailing Address - Country:US
Mailing Address - Phone:720-975-6425
Mailing Address - Fax:
Practice Address - Street 1:2215 ALCAZAR ST APT 402
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1003
Practice Address - Country:US
Practice Address - Phone:720-975-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAINT46571390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program