Individual
MRS. TAYLER SUZANNE KOPPERUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RCS, RVS
Contact information
Practice address
4959 PALO VERDE ST STE 208C-4, MONTCLAIR, CA 91763-2360
(909) 675-7362
Mailing address
4959 PALO VERDE ST STE 208C-4, MONTCLAIR, CA 91763-2360
(909) 675-7362
Taxonomy
Speciality
Code
Description
License number
State
246XC2903X
Vascular Specialist/Technologist Cardiovascular
00868169
CA
246XS1301X
Sonography Specialist/Technologist Cardiovascular
Primary
00868169
CA
Other
Enumeration date
09/25/2019
Last updated
05/11/2020
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