Basic Information
| Provider Information | |||||||||
| NPI: | 1013107275 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUPP | ||||||||
| FirstName: | JOHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2901 W. COAST HWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926634045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498911297 | ||||||||
| FaxNumber: | 9496258010 | ||||||||
| Practice Location | |||||||||
| Address1: | 2901 W. COAST HWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926634045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498911297 | ||||||||
| FaxNumber: | 9496258010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2007 | ||||||||
| LastUpdateDate: | 09/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | A94016 | CA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.