Provider Demographics
NPI:1780632414
Name:TUPAC-YUPANQUI SAFRA, ANA LUISA (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:LUISA
Last Name:TUPAC-YUPANQUI SAFRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:L
Other - Last Name:SAFRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 211237
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33421-1237
Mailing Address - Country:US
Mailing Address - Phone:561-313-4884
Mailing Address - Fax:
Practice Address - Street 1:13005 SOUTHERN BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9206
Practice Address - Country:US
Practice Address - Phone:561-313-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91046207R00000X, 207RG0300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME91046OtherMEDICAL LICENSE
FL28808ZMedicare ID - Type Unspecified
FLH12557Medicare UPIN