Provider Demographics
NPI:1821862475
Name:PARRA, LUPE KATHERINE
Entity Type:Individual
Prefix:
First Name:LUPE
Middle Name:KATHERINE
Last Name:PARRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUPE
Other - Middle Name:KATHERINE
Other - Last Name:PARRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5201 N 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2714
Mailing Address - Country:US
Mailing Address - Phone:480-953-6003
Mailing Address - Fax:
Practice Address - Street 1:5201 N 23RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2714
Practice Address - Country:US
Practice Address - Phone:480-953-6003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi