Healthcare Provider Details

I. General information

NPI: 1982145074
Provider Name (Legal Business Name): ANJALI GUPTA MD CCFP FRCSC FACOG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 02/06/2022
Certification Date: 02/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 HOSPITAL RD STE 316
NEWPORT BEACH CA
92663-3505
US

IV. Provider business mailing address

351 HOSPITAL RD STE 316
NEWPORT BEACH CA
92663-3505
US

V. Phone/Fax

Practice location:
  • Phone: 949-642-5775
  • Fax: 949-642-2073
Mailing address:
  • Phone: 949-642-5775
  • Fax: 949-642-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC142815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: