Provider Demographics
NPI:1881070852
Name:TUPUA, LALITA
Entity type:Individual
Prefix:
First Name:LALITA
Middle Name:
Last Name:TUPUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E 15TH AVE
Mailing Address - Street 2:APT 411
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-5234
Mailing Address - Country:US
Mailing Address - Phone:907-310-0117
Mailing Address - Fax:
Practice Address - Street 1:4119 LAUREL ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5334
Practice Address - Country:US
Practice Address - Phone:907-248-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMP1027225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist