Provider Demographics
NPI:1184686156
Name:HOROUPIAN, RUPERT ROUPEN (MD)
Entity Type:Individual
Prefix:
First Name:RUPERT
Middle Name:ROUPEN
Last Name:HOROUPIAN
Suffix:
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 1:27206 CALAROGA AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4300
Mailing Address - Country:US
Mailing Address - Phone:510-732-5731
Mailing Address - Fax:510-732-5739
Practice Address - Street 1:365 HAWTHORNE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3107
Practice Address - Country:US
Practice Address - Phone:510-465-5523
Practice Address - Fax:510-832-6061
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84866174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA128914Medicare UPIN