Provider Demographics
NPI:1548495526
Name:ANSHU GUPTA MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ANSHU GUPTA MD A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CRISTINA
Authorized Official - Last Name:VALLE-SENTENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-436-7600
Mailing Address - Street 1:700 GARDEN VIEW CT STE 208
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2478
Mailing Address - Country:US
Mailing Address - Phone:760-436-7600
Mailing Address - Fax:760-436-7606
Practice Address - Street 1:700 GARDEN VIEW CT STE 208
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2478
Practice Address - Country:US
Practice Address - Phone:760-436-7600
Practice Address - Fax:760-436-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87872208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABU648AMedicare UPIN
CABU651ZMedicare UPIN