Healthcare Provider Details

I. General information

NPI: 1265628473
Provider Name (Legal Business Name): MADHU GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 OWENS DR STE 210
PLEASANTON CA
94588-3980
US

IV. Provider business mailing address

PO BOX 102858
PASADENA CA
91189-2858
US

V. Phone/Fax

Practice location:
  • Phone: 925-224-0740
  • Fax: 925-244-0713
Mailing address:
  • Phone: 925-952-2828
  • Fax: 925-952-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA101257
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: