Healthcare Provider Details

I. General information

NPI: 1447967922
Provider Name (Legal Business Name): CUPID MEDICAL OF CALIFORNIA P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 ALMADEN BLVD STE 600
SAN JOSE CA
95113-1605
US

IV. Provider business mailing address

8 THE GRN STE 11670
DOVER DE
19901-3618
US

V. Phone/Fax

Practice location:
  • Phone: 323-894-9294
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CONNER WALSH
Title or Position: CONSULTANT
Credential:
Phone: 323-894-9294