Provider Demographics
NPI:1952004020
Name:GUPTA, SANITHA BABU (NP)
Entity Type:Individual
Prefix:
First Name:SANITHA
Middle Name:BABU
Last Name:GUPTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SANITHA
Other - Middle Name:
Other - Last Name:BABU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 INNOVATOR DR UNIT 11103
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3884
Mailing Address - Country:US
Mailing Address - Phone:518-602-3602
Mailing Address - Fax:
Practice Address - Street 1:4000 INNOVATOR DR UNIT 11103
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3884
Practice Address - Country:US
Practice Address - Phone:518-602-3602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95197644363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily