Provider Demographics
NPI:1336038892
Name:SAUPAN, MICHELLE PEREA (NP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:PEREA
Last Name:SAUPAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 N AVENIDA ALIPAZ
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2239
Mailing Address - Country:US
Mailing Address - Phone:626-617-7360
Mailing Address - Fax:
Practice Address - Street 1:888 BREA CANYON RD STE 330
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91789-3095
Practice Address - Country:US
Practice Address - Phone:909-594-3382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily