Provider Demographics
NPI:1679578090
Name:COPPOLA, ALFRED J (MD)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:J
Last Name:COPPOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2326
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93303-2326
Mailing Address - Country:US
Mailing Address - Phone:661-663-6550
Mailing Address - Fax:
Practice Address - Street 1:300 OLD RIVER RD STE 200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9506
Practice Address - Country:US
Practice Address - Phone:661-663-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39988207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8735418Medicaid
CABW353ZMedicare PIN
CA8735418Medicaid
CA8735418Medicaid