Provider Demographics
NPI:1811101686
Name:CDT DR. ENRIQUE KOPPISH
Entity type:Organization
Organization Name:CDT DR. ENRIQUE KOPPISH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LIC
Authorized Official - Phone:787-480-3586
Mailing Address - Street 1:PO BOX 21405
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-1405
Mailing Address - Country:US
Mailing Address - Phone:787-480-3876
Mailing Address - Fax:787-758-9962
Practice Address - Street 1:404 AVE BARBOSA ESQ CALLE SICILIA RIO PIEDRAS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-480-3586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR030364OtherCRUZ AZL
PR9230049OtherHUMANA TODOS
PR=========OtherCIGNA EXCLUSIVE
PR=========OtherMAPHRE HEALTH MED ADV
PR6604270EKMedicaid
PR=========OtherAMERICAN HEALTH
PR=========OtherCIGNA PREFERRED
PR1138OtherPROSAM
PR=========Medicaid
PR6604270EKOtherCOSVI PRIVADO
PR700031OtherMMM
PR=========OtherMCS LIFE
PRN875OtherFIRST MEDICAL
PR1001051OtherACCA
PR=========OtherPAN AMERICAN
PR=========OtherGOLDEN CROSS
PR=========OtherMCS LIFE
PR=========OtherGOLDEN CROSS
PR=========OtherCIGNA PREFERRED
PR6604270EKOtherCOSVI PRIVADO