Healthcare Provider Details

I. General information

NPI: 1669869848
Provider Name (Legal Business Name): ANKUR SUDHIR GUPTA MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23501 CINEMA DR STE 109
VALENCIA CA
91355-5429
US

IV. Provider business mailing address

525 E MICHELTORENA ST STE A
SANTA BARBARA CA
93103-4211
US

V. Phone/Fax

Practice location:
  • Phone: 661-253-2939
  • Fax:
Mailing address:
  • Phone: 805-963-1648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberA188582
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA188582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: