Provider Demographics
NPI:1396927257
Name:LUPPINO, JULIO C
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:C
Last Name:LUPPINO
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 1:9017 RESEDA BLVD.
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3970
Mailing Address - Country:US
Mailing Address - Phone:818-830-2630
Mailing Address - Fax:818-830-2970
Practice Address - Street 1:9017 RESEDA BLVD
Practice Address - Street 2:SUITE # 103
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3922
Practice Address - Country:US
Practice Address - Phone:818-830-2630
Practice Address - Fax:818-830-2970
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50183332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03420FMedicaid
CADME03420FMedicaid