Provider Demographics
NPI:1588768196
Name:COPELAN, COLLEEN (MD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:COPELAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 OLD CONEJO RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2115
Mailing Address - Country:US
Mailing Address - Phone:805-388-3337
Mailing Address - Fax:805-388-1555
Practice Address - Street 1:970 SOUTH PETIT AVE
Practice Address - Street 2:STE A
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004
Practice Address - Country:US
Practice Address - Phone:805-659-1333
Practice Address - Fax:805-659-1408
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG220182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG22018OtherLICENSE