MEDICARE: LUPE HUESCA ACUPIDO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist		CA
2	225700000X	Massage Therapist	15713	CA

General Provider Information

NPI Number	:	1568173581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUPE HUESCA ACUPIDO

Provider Business Mailing Address
First Line	:	4725 DONNIE LYN WAY
Second Line	:
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-3519
Country	:	US
Telephone Number	:	408-893-2051
Fax Number	:

Provider Business Practice Location Address
First Line	:	1174 LINCOLN AVE STE 7
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-3029
Country	:	US
Telephone Number	:	408-293-6520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2022
Last Update Date	:	12/09/2022

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Directions to “ LUPE HUESCA ACUPIDO ” Practice Location

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