Provider Demographics
NPI:1982145074
Name:GUPTA, ANJALI (MD CCFP FRCSC FACOG)
Entity Type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD CCFP FRCSC FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 HOSPITAL RD STE 316
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3505
Mailing Address - Country:US
Mailing Address - Phone:949-642-5775
Mailing Address - Fax:949-642-2073
Practice Address - Street 1:351 HOSPITAL RD STE 316
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3505
Practice Address - Country:US
Practice Address - Phone:949-642-5775
Practice Address - Fax:949-642-2073
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC142815207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology