Provider Demographics
NPI:1417464363
Name:GUPTA, PRANJAL BODH
Entity Type:Individual
Prefix:
First Name:PRANJAL
Middle Name:BODH
Last Name:GUPTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WELCH RD STE 350
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1807
Mailing Address - Country:US
Mailing Address - Phone:650-723-6576
Mailing Address - Fax:
Practice Address - Street 1:900 WELCH RD STE 350
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1807
Practice Address - Country:US
Practice Address - Phone:650-723-6576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-01
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2833207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine