| Lieu Rupp, M.d. Inc. | |
|
4440 Brockton Ave Ste 100 Riverside CA 92501-4026 | |
| (951) 369-0138 | |
| (951) 369-1028 |
| Full Name | Lieu Rupp, M.d. Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 4440 Brockton Ave Ste 100, Riverside, California |
| Authorized Official Name and Position | Lieu Rupp (OWNER) |
| Authorized Official Contact | 9513690138 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lieu Rupp, M.d. Inc. 4440 Brockton Ave Ste 100 Riverside CA 92501-4026 Ph: (951) 369-0138 | Lieu Rupp, M.d. Inc. 4440 Brockton Ave Ste 100 Riverside CA 92501-4026 Ph: (951) 369-0138 |
| NPI Number | 1962688614 |
|---|---|
| Provider Enumeration Date | 01/11/2008 |
| Last Update Date | 01/11/2008 |
| Medicare PECOS PAC ID | 4981787371 |
|---|---|
| Medicare Enrollment ID | O20080207000628 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962688614 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G064515 (California) | Primary |
| Provider Name | Lieu T Rupp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508957127 PECOS PAC ID: 9032117999 Enrollment ID: I20061201000297 |
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