Provider Demographics
NPI:1669049938
Name:PUPO, REY MOISES
Entity type:Individual
Prefix:
First Name:REY
Middle Name:MOISES
Last Name:PUPO
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 1:626 NW 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-5628
Mailing Address - Country:US
Mailing Address - Phone:786-286-8501
Mailing Address - Fax:
Practice Address - Street 1:626 NW 33RD AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-5628
Practice Address - Country:US
Practice Address - Phone:786-286-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant