Provider Demographics
NPI:1841712817
Name:KOPILOVA, TATYANA (MD)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:KOPILOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WEST PUEBLO STREET
Mailing Address - Street 2:SANTA BARBARA COTTAGE HOSPITAL
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93104
Mailing Address - Country:US
Mailing Address - Phone:805-569-7316
Mailing Address - Fax:805-569-7317
Practice Address - Street 1:401 BICENTENNIAL WAY FL 22
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2149
Practice Address - Country:US
Practice Address - Phone:707-393-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA159268208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery