Provider Demographics
NPI:1811901580
Name:GUPTA, LEENA K (MD)
Entity type:Individual
Prefix:DR
First Name:LEENA
Middle Name:K
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:4945 BRIDGEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2702
Mailing Address - Country:US
Mailing Address - Phone:408-666-0392
Mailing Address - Fax:601-984-5503
Practice Address - Street 1:5189 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-9524
Practice Address - Country:US
Practice Address - Phone:209-966-3631
Practice Address - Fax:209-966-3776
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS268512084A2900X
WAMD00042605207R00000X
CAA98907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
H92524Medicare UPIN