Provider Demographics
NPI:1598795346
Name:LUPENA, HAZEL JOYCE ZALDIVIA (MD)
Entity Type:Individual
Prefix:DR
First Name:HAZEL JOYCE
Middle Name:ZALDIVIA
Last Name:LUPENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16259 SYLVESTER RD SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3049
Mailing Address - Country:US
Mailing Address - Phone:206-241-1818
Mailing Address - Fax:360-744-6270
Practice Address - Street 1:16259 SYLVESTER RD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3049
Practice Address - Country:US
Practice Address - Phone:206-241-1818
Practice Address - Fax:360-744-6270
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102309207RC0200X, 207RP1001X
WAMD60934777207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2140527Medicaid
FLME102309OtherDEPARTMENT OF HEALTH FL LICENSE
ME102309OtherFLORIDA MEDICAL LICENSE