Provider Demographics
NPI:1336140458
Name:GUPTA, ABHA S (MD)
Entity Type:Individual
Prefix:DR
First Name:ABHA
Middle Name:S
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N TUSTIN AVE
Mailing Address - Street 2:# 201
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3612
Mailing Address - Country:US
Mailing Address - Phone:714-558-7277
Mailing Address - Fax:714-558-3075
Practice Address - Street 1:801 N TUSTIN AVE
Practice Address - Street 2:# 201
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3612
Practice Address - Country:US
Practice Address - Phone:714-558-7277
Practice Address - Fax:714-558-3075
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41163174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41163Medicare ID - Type Unspecified
CAF19493Medicare UPIN