Provider Demographics
NPI:1114654993
Name:LUPERCIO, JULIA MONET
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MONET
Last Name:LUPERCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:MONET
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8459
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-8459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7511 SE HENRY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-6445
Practice Address - Country:US
Practice Address - Phone:503-771-6061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant