Provider Demographics
NPI:1205473154
Name:GUPTE, GARGI DNYANESH (PA-C)
Entity type:Individual
Prefix:
First Name:GARGI
Middle Name:DNYANESH
Last Name:GUPTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 FANNIN ST STE 1014
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-5301
Mailing Address - Country:US
Mailing Address - Phone:832-325-7080
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 1014
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5301
Practice Address - Country:US
Practice Address - Phone:832-325-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA19134363A00000X
COPA.0008035363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant