Healthcare Provider Details

I. General information

NPI: 1548697378
Provider Name (Legal Business Name): JOELLE KUPRAS M.S.SP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2013
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 BOULDER CT SUITE 300
PLEASANTON CA
94566-8326
US

IV. Provider business mailing address

3839 INVERNESS CMN
LIVERMORE CA
94551-4906
US

V. Phone/Fax

Practice location:
  • Phone: 510-697-9526
  • Fax:
Mailing address:
  • Phone: 510-697-9526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 10489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: