Provider Demographics
NPI:1952340499
Name:GUPTA, ATUL (DO)
Entity Type:Individual
Prefix:
First Name:ATUL
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 ATLANTIC AVE
Mailing Address - Street 2:DEPT OF EMERGENCY MEDICINE
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1701
Mailing Address - Country:US
Mailing Address - Phone:562-933-1411
Mailing Address - Fax:562-933-1412
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:DEPT OF EMERGENCY MED
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1701
Practice Address - Country:US
Practice Address - Phone:562-933-2000
Practice Address - Fax:818-587-2493
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7636207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00110248OtherRAILROAD MEDICARE
CA00AX76360Medicaid
CA020A76360OtherBLUE SHIELD
CA00AX76360Medicaid
CAH87394Medicare UPIN