Organization
CDT DR. ENRIQUE KOPPISH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGELIZ RODRIGUEZ LIC (ADMINISTRATOR)
(787) 480-3586
Entity
Organization
Contact information
Practice address
404 AVE BARBOSA ESQ CALLE SICILIA RIO PIEDRAS, SAN JUAN, PR 00924
(787) 480-3586
Mailing address
PO BOX 21405, SAN JUAN, PR 00928-1405
(787) 480-3876
(787) 758-9962
Taxonomy
Speciality
Code
Description
License number
State
261QP0905X
State or Local Public Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030364
CRUZ AZL
PR
01
—
1001051
ACCA
PR
01
—
1138
PROSAM
PR
01
—
6604270EK
COSVI PRIVADO
PR
05
—
6604270EK
—
PR
01
—
700031
MMM
PR
01
—
9230049
HUMANA TODOS
PR
01
—
=========
CIGNA EXCLUSIVE
PR
05
—
=========
—
PR
01
—
N875
FIRST MEDICAL
PR
Enumeration date
05/10/2007
Last updated
02/27/2024
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