Provider Demographics
NPI:1134247034
Name:HERNANDEZ-TUPTA, BEATRIZ (DC)
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:HERNANDEZ-TUPTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4287 VERDUGO VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-4359
Mailing Address - Country:US
Mailing Address - Phone:323-256-2540
Mailing Address - Fax:
Practice Address - Street 1:1551 COLORADO BLVD # 104
Practice Address - Street 2:
Practice Address - City:EAGLE ROCK
Practice Address - State:CA
Practice Address - Zip Code:90041-1400
Practice Address - Country:US
Practice Address - Phone:323-344-8879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor