Provider Demographics
NPI:1043574403
Name:GUPTA, ANUSHREE
Entity Type:Individual
Prefix:
First Name:ANUSHREE
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N PEPPER AVE
Mailing Address - Street 2:MOB SUITE 301
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1801
Mailing Address - Country:US
Mailing Address - Phone:909-580-3366
Mailing Address - Fax:909-580-3332
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:MOB SUITE 301
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-3366
Practice Address - Fax:909-580-3332
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-01
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126104208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist