Healthcare Provider Details

I. General information

NPI: 1407902331
Provider Name (Legal Business Name): VINOD K GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WILLOW PLZ STE 200
VISALIA CA
93291-6213
US

IV. Provider business mailing address

100 WILLOW PLZ STE 200
VISALIA CA
93291-6213
US

V. Phone/Fax

Practice location:
  • Phone: 559-733-7010
  • Fax: 559-733-3671
Mailing address:
  • Phone: 559-733-7010
  • Fax: 559-733-3671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA45899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: