Provider Demographics
NPI:1700758646
Name:TUPAZ, JULIE ANN JAVIER
Entity type:Individual
Prefix:
First Name:JULIE ANN
Middle Name:JAVIER
Last Name:TUPAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 GATUN ST UNIT 259
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-1360
Mailing Address - Country:US
Mailing Address - Phone:510-512-8342
Mailing Address - Fax:
Practice Address - Street 1:783 GATUN ST UNIT 259
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-1360
Practice Address - Country:US
Practice Address - Phone:510-512-8342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-20
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035985363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care