Provider Demographics
NPI:1750136271
Name:TUPA, JESSICA L (MDS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:TUPA
Suffix:
Gender:F
Credentials:MDS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 CASBURY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1785
Mailing Address - Country:US
Mailing Address - Phone:210-268-8254
Mailing Address - Fax:
Practice Address - Street 1:5206 CASBURY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1785
Practice Address - Country:US
Practice Address - Phone:210-268-8254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86623133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered