Provider Demographics
NPI:1609805514
Name:KOPERSKI, JUDITH ANN (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:KOPERSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3613 VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4522
Mailing Address - Country:US
Mailing Address - Phone:760-758-5340
Mailing Address - Fax:760-758-5502
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:530
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-558-0677
Practice Address - Fax:858-558-3077
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG51030207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF05346Medicare ID - Type Unspecified
CAF05346Medicare UPIN