Healthcare Provider Details

I. General information

NPI: 1750319265
Provider Name (Legal Business Name): SUNITA GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 S VAL VISTA DR #103
GILBERT AZ
85297-7313
US

IV. Provider business mailing address

3885 S VAL VISTA DR #103
GILBERT AZ
85297-7313
US

V. Phone/Fax

Practice location:
  • Phone: 480-269-8436
  • Fax: 480-269-8438
Mailing address:
  • Phone: 480-269-8436
  • Fax: 480-269-8438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41594
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: