Healthcare Provider Details

I. General information

NPI: 1285213157
Provider Name (Legal Business Name): MONICA ANITA GUPTA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5190 CAMPUS DR
NEWPORT BEACH CA
92660-2101
US

IV. Provider business mailing address

5190 CAMPUS DR
NEWPORT BEACH CA
92660-2101
US

V. Phone/Fax

Practice location:
  • Phone: 949-557-0951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A21049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: