Provider Demographics
NPI:1659588754
Name:GUPTA, SHILPA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHILPA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHILPA
Other - Middle Name:
Other - Last Name:DEWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3660 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3912
Mailing Address - Country:US
Mailing Address - Phone:951-782-3045
Mailing Address - Fax:951-274-0809
Practice Address - Street 1:7117 BROCKTON AVENUE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3912
Practice Address - Country:US
Practice Address - Phone:951-782-3635
Practice Address - Fax:951-784-3256
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0858662080P0205X
CAA1043402080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31887ZOtherPTAN