Healthcare Provider Details

I. General information

NPI: 1699179283
Provider Name (Legal Business Name): HINA T GUPTA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E SAMPLE RD STE 105
POMPANO BEACH FL
33064-4443
US

IV. Provider business mailing address

601 E SAMPLE RD STE 105
POMPANO BEACH FL
33064-4443
US

V. Phone/Fax

Practice location:
  • Phone: 954-773-2383
  • Fax: 954-783-6845
Mailing address:
  • Phone: 954-773-2383
  • Fax: 954-783-6845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME113564
License Number StateFL

VIII. Authorized Official

Name: HINA T GUPTA
Title or Position: OWNER
Credential: MD
Phone: 319-621-8376