Provider Demographics
NPI:1629165428
Name:GUPTA, ABHAY (MD)
Entity Type:Individual
Prefix:
First Name:ABHAY
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10672 WEXFORD STREET
Mailing Address - Street 2:SUITE 275
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131
Mailing Address - Country:US
Mailing Address - Phone:858-621-6000
Mailing Address - Fax:858-621-6340
Practice Address - Street 1:10672 WEXFORD STREET
Practice Address - Street 2:SUITE 275
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131
Practice Address - Country:US
Practice Address - Phone:858-621-6000
Practice Address - Fax:858-621-6340
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-05-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA88550208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88550OtherCALIFORNIA STATE LICENSE
CAA88550OtherCALIFORNIA STATE LICENSE
CAH13809Medicare UPIN