Provider Demographics
NPI:1912340159
Name:GUPTA, AMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:AMAR
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6850 BROCKTON AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3814
Mailing Address - Country:US
Mailing Address - Phone:951-313-6843
Mailing Address - Fax:951-800-1850
Practice Address - Street 1:6850 BROCKTON AVE STE 108
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3814
Practice Address - Country:US
Practice Address - Phone:951-313-6843
Practice Address - Fax:951-800-1850
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1670292082S0099X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery