Provider Demographics
NPI:1891783692
Name:GUPTA, SHALINI (MD)
Entity Type:Individual
Prefix:
First Name:SHALINI
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 1:414 G ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5663
Mailing Address - Country:US
Mailing Address - Phone:530-741-2393
Mailing Address - Fax:530-741-2396
Practice Address - Street 1:414 G ST
Practice Address - Street 2:SUITE 240
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5663
Practice Address - Country:US
Practice Address - Phone:530-741-2393
Practice Address - Fax:530-741-2396
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA82415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI04998Medicare UPIN