Provider Demographics
NPI:1902584212
Name:TUPAZ, JESUS RHAYMANN LAGMAN (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:JESUS RHAYMANN
Middle Name:LAGMAN
Last Name:TUPAZ
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7529 GEORGICA WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-5835
Mailing Address - Country:US
Mailing Address - Phone:916-203-9978
Mailing Address - Fax:
Practice Address - Street 1:7529 GEORGICA WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-5835
Practice Address - Country:US
Practice Address - Phone:916-203-9978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95284896163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator