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Individual

ANA LUISA TUPAC-YUPANQUI SAFRA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
13005 SOUTHERN BLVD, SUITE 225, LOXAHATCHEE, FL 33470-9206
(561) 313-4884
Mailing address
PO BOX 211237, ROYAL PALM BEACH, FL 33421-1237
(561) 313-4884

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME91046
FL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
ME91046
FL
208D00000X
General Practice Physician
ME91046
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
ME91046
MEDICAL LICENSE
FL
Enumeration date
05/05/2006
Last updated
07/22/2010
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