Provider Demographics
NPI:1851615520
Name:GUPTA, RESHMA (MD)
Entity Type:Individual
Prefix:MS
First Name:RESHMA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10945 LE CONTE AVE
Mailing Address - Street 2:SUITE 1401, UEBERROTH BUILDING
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3000
Mailing Address - Country:US
Mailing Address - Phone:310-206-8687
Mailing Address - Fax:310-206-7975
Practice Address - Street 1:4860 Y ST STE 1600
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60340270207R00000X
CAA128870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1851615520Medicaid
WA1851615520Medicaid