Provider Demographics
NPI:1871024554
Name:GUPTA, TANYA JAIN (MD, MS)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:JAIN
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 DEERWOOD RD
Mailing Address - Street 2:STE 305
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1530
Mailing Address - Country:US
Mailing Address - Phone:925-938-5252
Mailing Address - Fax:925-938-1343
Practice Address - Street 1:111 DEERWOOD RD STE 305
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1530
Practice Address - Country:US
Practice Address - Phone:925-938-5252
Practice Address - Fax:925-938-1343
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1572642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty