Healthcare Provider Details

I. General information

NPI: 1003592395
Provider Name (Legal Business Name): ILESHA GUPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18173 PIONEER BLVD STE 1
ARTESIA CA
90701-3977
US

IV. Provider business mailing address

18173 PIONEER BLVD STE 1
ARTESIA CA
90701-3977
US

V. Phone/Fax

Practice location:
  • Phone: 562-403-0488
  • Fax:
Mailing address:
  • Phone: 562-403-0488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: