Provider Demographics
NPI:1013107275
Name:CUPP, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CUPP
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 1:2901 W. COAST HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4045
Mailing Address - Country:US
Mailing Address - Phone:949-891-1297
Mailing Address - Fax:949-625-8010
Practice Address - Street 1:2901 W. COAST HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4045
Practice Address - Country:US
Practice Address - Phone:949-891-1297
Practice Address - Fax:949-625-8010
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94016207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology