1437253721 NPI number — DEBORAH ERNESTINE KOPEC RN

Table of content: DEBORAH ERNESTINE KOPEC RN (NPI 1437253721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437253721 NPI number — DEBORAH ERNESTINE KOPEC RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOPEC
Provider First Name:
DEBORAH
Provider Middle Name:
ERNESTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIXON
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
ERNESTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437253721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 VICENTE ST
Provider Second Line Business Mailing Address:
EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94116-2923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-681-3211
Provider Business Mailing Address Fax Number:
415-664-7094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 VICENTE ST
Provider Second Line Business Practice Location Address:
EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94116-2923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-681-3211
Provider Business Practice Location Address Fax Number:
415-664-7094
Provider Enumeration Date:
09/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  497492 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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