Healthcare Provider Details

I. General information

NPI: 1144597444
Provider Name (Legal Business Name): PAUL MICHEAL HUPP PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 SHERMAN DR SUITE 3
RIVERSIDE CA
92503-4001
US

IV. Provider business mailing address

3838 SHERMAN DRIVE SUITE 3
RIVERSIDE CA
92504-4001
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-9800
  • Fax: 951-688-1580
Mailing address:
  • Phone: 951-688-9800
  • Fax: 951-688-1580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA21767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: