# COPPELL CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114358413
- **Authorized official:** MANOHAR VAJJA MD (PHYSICIAN)
- **Authorized official phone:** (972) 899-1911

## Contact information

- **Practice address:** 651 N DENTON TAP RD STE 100, COPPELL, TX 75019-2010
- **Practice address phone:** (214) 886-8496
- **Mailing address:** 651 N DENTON TAP RD SUITE 100, COPPELL, TX 75019
- **Mailing address phone:** (972) 899-1911

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 173000000X | Legal Medicine | M7714 | TX | Yes |

## Other

- **Enumeration date:** 12/12/2013
- **Last updated:** 04/28/2014