Provider Demographics
NPI:1558191866
Name:CUPA JIMENEZ, OSCAR ULISES
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:ULISES
Last Name:CUPA JIMENEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CIRCUITO MOSSA 141
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:GUANAJUATO
Mailing Address - Zip Code:37235
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CIRCUITO MOSSA 141
Practice Address - Street 2:
Practice Address - City:LEON
Practice Address - State:GUANAJUATO
Practice Address - Zip Code:37235
Practice Address - Country:MX
Practice Address - Phone:477-701-9182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1101001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice