Provider Demographics
NPI:1154358943
Name:LUPO, JENNIFER M (MS, ATC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:LUPO
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Gender:F
Credentials:MS, ATC
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Mailing Address - Street 1:1231 S GOLDEN WEST AVE
Mailing Address - Street 2:UNIT 12
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7456
Mailing Address - Country:US
Mailing Address - Phone:626-419-4261
Mailing Address - Fax:909-869-2814
Practice Address - Street 1:3801 W TEMPLE AVE
Practice Address - Street 2:ATHLETIC DEPARTMENT
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-2557
Practice Address - Country:US
Practice Address - Phone:909-869-2820
Practice Address - Fax:909-869-2814
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer