MEDICARE: KARINA ESTEFANIA LUPIAN ASW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	ASW119993	CA
2	1041C0700X	Clinical Social Worker	F3501236	CA
3	104100000X	Social Worker	ASW119993	CA

General Provider Information

NPI Number	:	1487340121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARINA ESTEFANIA LUPIAN ASW

Provider Business Mailing Address
First Line	:	679 JOSHUA TREE ST
Second Line	:
City	:	IMPERIAL
State	:	CA
Zip	:	92251-8917
Country	:	US
Telephone Number	:	760-925-1814
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 HACIENDA DR STE A
Second Line	:
City	:	CALEXICO
State	:	CA
Zip	:	92231-1889
Country	:	US
Telephone Number	:	442-265-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2023
Last Update Date	:	03/14/2024

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