Healthcare Provider Details

I. General information

NPI: 1659588754
Provider Name (Legal Business Name): SHILPA GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHILPA DEWAN M.D.

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 BROCKTON AVENUE
RIVERSIDE CA
92506-3912
US

IV. Provider business mailing address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-3635
  • Fax: 951-784-3256
Mailing address:
  • Phone: 951-782-3635
  • Fax: 951-784-3256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number35.085866
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberA104340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: