Provider Demographics
NPI:1205810280
Name:LUPIAN, ALFONSO (PA-C)
Entity type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:
Last Name:LUPIAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13722 EMBASSY ROW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2000
Mailing Address - Country:US
Mailing Address - Phone:210-349-5577
Mailing Address - Fax:210-491-2868
Practice Address - Street 1:7471 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2457
Practice Address - Country:US
Practice Address - Phone:559-436-4500
Practice Address - Fax:559-261-1526
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16545363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21572ZOtherGROUP PTAN FOR BAZ ALLERGY, ASTHMA & SINUS CENTER