Provider Demographics
NPI:1740243609
Name:GUPTA, PRAGYA B (MD)
Entity Type:Individual
Prefix:
First Name:PRAGYA
Middle Name:B
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 CITRACADO PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-4112
Mailing Address - Country:US
Mailing Address - Phone:760-738-5533
Mailing Address - Fax:760-738-5533
Practice Address - Street 1:1955 CITRACADO PKWY STE 203
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4112
Practice Address - Country:US
Practice Address - Phone:760-738-5533
Practice Address - Fax:760-738-3835
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC152074207LP2900X, 208VP0014X
KY34920208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65936809Medicaid
KY6434920200Medicaid
KY7047Medicare PIN
G97203Medicare UPIN
KY7048Medicare PIN
KY65936809Medicaid