Provider Demographics
NPI:1346207180
Name:RIES, SAVITA GUPTA (MD)
Entity Type:Individual
Prefix:
First Name:SAVITA
Middle Name:GUPTA
Last Name:RIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2801 ATLANTIC AVE
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1701
Mailing Address - Country:US
Mailing Address - Phone:562-933-0727
Mailing Address - Fax:562-933-0791
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1701
Practice Address - Country:US
Practice Address - Phone:562-933-0727
Practice Address - Fax:562-933-0791
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79020207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G790200Medicaid
G77930Medicare UPIN
CA00G790200Medicaid
CAWG79020BMedicare PIN