Individual
MR. JERRY JOSEPH STUPAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
REGISTERED NURSE
Contact information
Practice address
10605 BALBOA BLVD STE 100, GRANADA HILLS, CA 91344-6367
(818) 366-0325
(818) 363-8951
Mailing address
10605 BALBOA BLVD STE 100, GRANADA HILLS, CA 91344-6367
(818) 366-0325
(818) 363-8951
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
613194
CA
Other
Enumeration date
12/04/2006
Last updated
07/08/2007
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