Healthcare Provider Details

I. General information

NPI: 1164612081
Provider Name (Legal Business Name): SATISH GUPTA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2258 FOOTHILL BLVD SUITE #100
LA CANADA CA
91011-1457
US

IV. Provider business mailing address

2258 FOOTHILL BLVD SUITE #100
LA CANADA CA
91011-1457
US

V. Phone/Fax

Practice location:
  • Phone: 818-249-7200
  • Fax: 818-249-7210
Mailing address:
  • Phone: 818-249-7200
  • Fax: 818-249-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA29545
License Number StateCA

VIII. Authorized Official

Name: DR. SATISH STEVE GUPTA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-249-7200