Healthcare Provider Details

I. General information

NPI: 1790946440
Provider Name (Legal Business Name): ANKMALIKA ABHA GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANKMALIKA ABHA GUPTA LOUIS MD

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA DRIVE
IRVINE CA
92697-3634
US

IV. Provider business mailing address

200 S MANCHESTER AVE STE 300
ORANGE CA
92868-3219
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-8600
  • Fax:
Mailing address:
  • Phone: 714-456-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA116893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: