Provider Demographics
NPI:1144597444
Name:HUPP, PAUL MICHEAL (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHEAL
Last Name:HUPP
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3838 SHERMAN DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-4001
Mailing Address - Country:US
Mailing Address - Phone:951-688-9800
Mailing Address - Fax:951-688-1580
Practice Address - Street 1:3838 SHERMAN DR
Practice Address - Street 2:SUITE 3
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4001
Practice Address - Country:US
Practice Address - Phone:951-688-9800
Practice Address - Fax:951-688-1580
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA21767363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical