Healthcare Provider Details

I. General information

NPI: 1851615520
Provider Name (Legal Business Name): RESHMA GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 1600
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

10945 LE CONTE AVE SUITE 1401, UEBERROTH BUILDING
LOS ANGELES CA
90095-3000
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2737
  • Fax:
Mailing address:
  • Phone: 310-206-8687
  • Fax: 310-206-7975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60340270
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA128870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: