Healthcare Provider Details

I. General information

NPI: 1265628473
Provider Name (Legal Business Name): MADHU GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 TREAT BLVD SUITE 120A
WALNUT CREEK CA
94597-2168
US

IV. Provider business mailing address

DEPT 34929 P.O. BOX 39000
SAN FRANCISCO CA
94139-0001
US

V. Phone/Fax

Practice location:
  • Phone: 925-296-9727
  • Fax: 925-296-9032
Mailing address:
  • Phone: 925-952-2828
  • Fax: 925-952-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA101257
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: