1205009222 NPI number — GINA M LUPO R.D.

Table of content: GINA M LUPO R.D. (NPI 1205009222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205009222 NPI number — GINA M LUPO R.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUPO
Provider First Name:
GINA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205009222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 S SHAMROCK AVE APT D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROVIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91016-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-357-2700
Provider Business Mailing Address Fax Number:
562-741-4413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11525 BROOKSHIRE AVE STE 301
Provider Second Line Business Practice Location Address:
ATTN MAGGIE NOLES
Provider Business Practice Location Address City Name:
DOWNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90241-4982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-741-4461
Provider Business Practice Location Address Fax Number:
562-741-4413
Provider Enumeration Date:
04/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  983732 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 983732 . This is a "CDR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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