Healthcare Provider Details

I. General information

NPI: 1881027050
Provider Name (Legal Business Name): DELIA DANIELA BUPTE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11696 CARLY CT
RIVERSIDE CA
92503-5984
US

IV. Provider business mailing address

11696 CARLY CT
RIVERSIDE CA
92503-5984
US

V. Phone/Fax

Practice location:
  • Phone: 951-359-4763
  • Fax: 951-359-4763
Mailing address:
  • Phone: 951-359-4763
  • Fax: 951-359-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number554219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: