1811101686 NPI number — CDT DR. ENRIQUE KOPPISH

Table of content: (NPI 1811101686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811101686 NPI number — CDT DR. ENRIQUE KOPPISH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CDT DR. ENRIQUE KOPPISH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811101686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21405
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00928-1405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-480-3876
Provider Business Mailing Address Fax Number:
787-758-9962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 AVE BARBOSA ESQ CALLE SICILIA RIO PIEDRAS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-480-3586
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
ANGELIZ
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-480-3586

Provider Taxonomy Codes

  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 030364 . This is a "CRUZ AZL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9230049 . This is a "HUMANA TODOS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "CIGNA EXCLUSIVE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "MAPHRE HEALTH MED ADV" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6604270EK , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: ========= . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "CIGNA PREFERRED" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1138 . This is a "PROSAM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ========= , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6604270EK . This is a "COSVI PRIVADO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 700031 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "MCS LIFE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: N875 . This is a "FIRST MEDICAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1001051 . This is a "ACCA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "PAN AMERICAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "GOLDEN CROSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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