Healthcare Provider Details

I. General information

NPI: 1518896836
Provider Name (Legal Business Name): VAIBHAV GUPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 LINDEN AVE. LONG BEACH CA 90813, ST. MARY MEDICAL 1050 LINDEN AVE. LONG BEACH CA 90813
LONG BEACH CA
90813
US

IV. Provider business mailing address

1050 LINDEN AVE. LONG BEACH CA 90813, ST. MARY MEDICAL 1050 LINDEN AVE. LONG BEACH CA 90813
LONG BEACH CA
90813
US

V. Phone/Fax

Practice location:
  • Phone: 562-491-9140
  • Fax: 562-491-9146
Mailing address:
  • Phone: 562-491-9140
  • Fax: 562-491-9146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: