Healthcare Provider Details

I. General information

NPI: 1902037047
Provider Name (Legal Business Name): MRINALI PATEL GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRINALI PATEL MD

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 E 1ST ST STE 140
SANTA ANA CA
92705-4079
US

IV. Provider business mailing address

2010 E 1ST ST STE 140
SANTA ANA CA
92705-4079
US

V. Phone/Fax

Practice location:
  • Phone: 714-543-6020
  • Fax:
Mailing address:
  • Phone: 714-543-6020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC167497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: