MEDICARE: MISS SARAH JOY LUPO SP

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	235Z00000X	Speech-Language Pathologist	SP18796	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SP18796	OTHER	CA	SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY AND HEARING AID DISPENSER BOARD

General Provider Information

NPI Number	:	1558657429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SARAH JOY LUPO SP

Provider Business Mailing Address
First Line	:	5359 E GREENMEADOW RD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1623
Country	:	US
Telephone Number	:	562-607-9940
Fax Number	:

Provider Business Practice Location Address
First Line	:	5359 E GREENMEADOW RD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1623
Country	:	US
Telephone Number	:	562-607-9940
Fax Number	:

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

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	06/20/2011

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Directions to “ MISS SARAH JOY LUPO SP” Practice Location

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