Basic Information
Provider Information
NPI: 1902959612
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KOPLIK
FirstName: SHERI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
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OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 26800 CROWN VALLEY PKWY
Address2: SUITE 250
City: MISSION VIEJO
State: CA
PostalCode: 926916384
CountryCode: US
TelephoneNumber: 9493643570
FaxNumber: 9493643430
Practice Location
Address1: 26800 CROWN VALLEY PKWY
Address2: SUITE 250
City: MISSION VIEJO
State: CA
PostalCode: 926916384
CountryCode: US
TelephoneNumber: 9493643570
FaxNumber: 9493643430
Other Information
ProviderEnumerationDate: 01/18/2007
LastUpdateDate: 11/05/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XA96659CAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RC0000XA96659CAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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