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General NPI Number Information
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NPI Number | 1780632414
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Entity Type | Individual
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Provider Name | ANA LUISA TUPAC-YUPANQUI SAFRA M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 13005 SOUTHERN BLVD SUITE 225
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9206
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Country | US
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Telephone | 561-313-4884
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 211237
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33421-1237
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Country | US
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Telephone | 561-313-4884
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME91046
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME91046
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME91046
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License Number State | FL
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