Provider Demographics
NPI:1730908146
Name:COPA DE ORO COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:COPA DE ORO COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:SADEGH
Authorized Official - Last Name:DOLATABADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-404-7171
Mailing Address - Street 1:1127 WILSHIRE BLVD STE 1112
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12052 IMPERIAL HWY
Practice Address - Street 2:STE 102
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:562-261-9330
Practice Address - Fax:562-543-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health