Individual
LIEU RUPP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4440 BROCKTON AVE STE 100, RIVERSIDE, CA 92501-4026
(951) 369-0138
(951) 369-1028
Mailing address
4440 BROCKTON AVE STE 100, RIVERSIDE, CA 92501-4026
(951) 369-0138
(951) 369-1028
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G64515
CA
Other
Enumeration date
09/27/2006
Last updated
12/15/2014
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