Healthcare Provider Details

I. General information

NPI: 1467779637
Provider Name (Legal Business Name): JITESH GUPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7033 N FRESNO ST STE 202
FRESNO CA
93720-2976
US

IV. Provider business mailing address

7033 N FRESNO ST STE 202
FRESNO CA
93720-2976
US

V. Phone/Fax

Practice location:
  • Phone: 559-438-4300
  • Fax:
Mailing address:
  • Phone: 559-438-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number032232
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: