Provider Demographics
NPI:1891929709
Name:GUPTA, SHARMA & LIVELY MD'S
Entity Type:Organization
Organization Name:GUPTA, SHARMA & LIVELY MD'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-733-7010
Mailing Address - Street 1:100 WILLOW PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6213
Mailing Address - Country:US
Mailing Address - Phone:559-733-7010
Mailing Address - Fax:
Practice Address - Street 1:100 WILLOW PLZ STE 200
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6213
Practice Address - Country:US
Practice Address - Phone:559-733-7010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A458990207RC0000X
CA00G562940207RC0000X
CA00A443400207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE24826Medicare UPIN
CAC29634Medicare UPIN
CAD79149Medicare UPIN