Healthcare Provider Details

I. General information

NPI: 1376676940
Provider Name (Legal Business Name): GABY MARTHA KUPERMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 VAN HOUTEN AVE
EL CAJON CA
92020-4429
US

IV. Provider business mailing address

8465 LA JOLLA SHORES DR
LA JOLLA CA
92037-3042
US

V. Phone/Fax

Practice location:
  • Phone: 619-401-3710
  • Fax: 619-401-3840
Mailing address:
  • Phone: 858-459-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number496420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: