1811101686 NPI number — CDT DR. ENRIQUE KOPPISH

Table of Contents

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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