Healthcare Provider Details

I. General information

NPI: 1649287004
Provider Name (Legal Business Name): SATISH STEVE GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: S. STEVE GUPTA M.D.

II. Dates (important events)

Enumeration Date: 08/01/2006
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
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 Code207KA0200X
TaxonomyAllergy Physician
License NumberA29545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: