Provider Demographics
NPI:1861165144
Name:PROTOTYPE HEALTH, INC
Entity type:Organization
Organization Name:PROTOTYPE HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPPERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:480-999-1717
Mailing Address - Street 1:2055 E SOUTHERN AVE STE F
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7507
Mailing Address - Country:US
Mailing Address - Phone:480-999-1717
Mailing Address - Fax:480-999-0773
Practice Address - Street 1:2055 E SOUTHERN AVE STE F
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7507
Practice Address - Country:US
Practice Address - Phone:480-999-1717
Practice Address - Fax:480-999-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-31
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty