Provider Demographics
NPI:1093825838
Name:LUPPI, ALFRED PHIILIP II (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:PHIILIP
Last Name:LUPPI
Suffix:II
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 1:868 A AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2646
Mailing Address - Country:US
Mailing Address - Phone:619-435-1079
Mailing Address - Fax:619-435-1079
Practice Address - Street 1:868 A AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-2646
Practice Address - Country:US
Practice Address - Phone:619-435-1079
Practice Address - Fax:619-435-1079
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC 36580208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87863Medicare UPIN