Provider Demographics
NPI:1275003212
Name:TUPARAN, LORETA SALUM (FNP)
Entity Type:Individual
Prefix:
First Name:LORETA
Middle Name:SALUM
Last Name:TUPARAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 KINGSBURY DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-1709
Mailing Address - Country:US
Mailing Address - Phone:909-556-1419
Mailing Address - Fax:
Practice Address - Street 1:1814 KINGSBURY DR
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-1709
Practice Address - Country:US
Practice Address - Phone:909-556-1419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565421163WH1000X
CA15401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH1000XNursing Service ProvidersRegistered NurseHospice