Healthcare Provider Details

I. General information

NPI: 1205810280
Provider Name (Legal Business Name): ALFONSO LUPIAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7471 N FRESNO ST
FRESNO CA
93720-2457
US

IV. Provider business mailing address

13722 EMBASSY ROW
SAN ANTONIO TX
78216-2000
US

V. Phone/Fax

Practice location:
  • Phone: 559-436-4500
  • Fax: 559-261-1526
Mailing address:
  • Phone: 210-349-5577
  • Fax: 210-491-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: