MEDICARE: AVANTIKA GUPTA PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1104466408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVANTIKA GUPTA PSYD

Provider Business Mailing Address
First Line	:	9320 SW BARBUR BLVD STE 380
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-5430
Country	:	US
Telephone Number	:	971-204-8925
Fax Number	:

Provider Business Practice Location Address
First Line	:	9320 SW BARBUR BLVD STE 380
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-5430
Country	:	US
Telephone Number	:	971-204-8925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2020
Last Update Date	:	09/16/2024

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Directions to “ AVANTIKA GUPTA PSYD” Practice Location

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