Provider Demographics
NPI:1598953549
Name:MAHESH C GUPTA MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MAHESH C GUPTA MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHESH
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-737-0640
Mailing Address - Street 1:760 WASHBURN AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3303
Mailing Address - Country:US
Mailing Address - Phone:951-737-0640
Mailing Address - Fax:951-737-1655
Practice Address - Street 1:760 WASHBURN AVE STE 7
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3303
Practice Address - Country:US
Practice Address - Phone:951-737-0640
Practice Address - Fax:951-737-1655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAHESH C GUPTA MD A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-03
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A363070Medicaid
CA1417056953OtherNPI
CA1417056953OtherNPI
CAA28035Medicare UPIN