Provider Demographics
NPI:1639733892
Name:RUPERTO, JUSTIN MAPILI
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:MAPILI
Last Name:RUPERTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4612 ALEKONA CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2676
Mailing Address - Country:US
Mailing Address - Phone:559-313-1573
Mailing Address - Fax:
Practice Address - Street 1:4612 ALEKONA CT
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2676
Practice Address - Country:US
Practice Address - Phone:559-313-1573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker