Provider Demographics
NPI:1255094793
Name:GUPTA, ANUBHAV (PA-C)
Entity Type:Individual
Prefix:
First Name:ANUBHAV
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:91-6221 KAPOLEI PKWY UNIT 106
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6103
Mailing Address - Country:US
Mailing Address - Phone:503-460-7619
Mailing Address - Fax:
Practice Address - Street 1:683 WAIANAE AVE
Practice Address - Street 2:
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96786
Practice Address - Country:US
Practice Address - Phone:808-433-8201
Practice Address - Fax:912-433-8217
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-12-03
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant