Provider Demographics
NPI:1962297051
Name:LUPIAN, VANESSA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:LUPIAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-4760
Mailing Address - Country:US
Mailing Address - Phone:209-483-2446
Mailing Address - Fax:
Practice Address - Street 1:2517 HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-4760
Practice Address - Country:US
Practice Address - Phone:209-483-2446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist