Healthcare Provider Details

I. General information

NPI: 1073629549
Provider Name (Legal Business Name): ANUJ GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 W VISTA WAY SUITE D
VISTA CA
92083-6030
US

IV. Provider business mailing address

2023 W VISTA WAY SUITE D
VISTA CA
92083-6030
US

V. Phone/Fax

Practice location:
  • Phone: 619-330-8771
  • Fax: 619-330-8772
Mailing address:
  • Phone: 619-330-8771
  • Fax: 619-330-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA85939
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA85939
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA85939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: