Provider Demographics
NPI:1093361164
Name:PUPO, KARLA VANESSA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:VANESSA
Last Name:PUPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1638
Mailing Address - Country:US
Mailing Address - Phone:702-385-0921
Mailing Address - Fax:
Practice Address - Street 1:1312 S 8TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1638
Practice Address - Country:US
Practice Address - Phone:702-385-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant