Provider Demographics
NPI:1376746834
Name:GUPTA, ANITA
Entity Type:Individual
Prefix:DR
First Name:ANITA
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 1:122 15TH ST UNIT 400
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-8017
Mailing Address - Country:US
Mailing Address - Phone:844-213-7246
Mailing Address - Fax:
Practice Address - Street 1:4849 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:844-213-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08924000207L00000X, 207LP2900X
DCDO034234207L00000X
CA173723207LP2900X
MDH0066001207LP2900X
PAOS014438207LP2900X
CA17372207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology