Provider Demographics
NPI:1922289628
Name:GUPTA, NEELAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NEELAM
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 1:341 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-4231
Mailing Address - Country:US
Mailing Address - Phone:951-654-9367
Mailing Address - Fax:951-654-0839
Practice Address - Street 1:341 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-4231
Practice Address - Country:US
Practice Address - Phone:951-654-9367
Practice Address - Fax:951-654-0839
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45395207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A453950Medicaid
CA00A453950Medicare UPIN