Healthcare Provider Details

I. General information

NPI: 1902056146
Provider Name (Legal Business Name): CHRISTINA HOFF GUPTA M.C., P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA HOFF VELLTURO M.C., P.C.

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7596 ESTATE AVE
HUDSON OH
44236-5369
US

IV. Provider business mailing address

7596 ESTATE AVE
HUDSON OH
44236-5369
US

V. Phone/Fax

Practice location:
  • Phone: 216-712-2012
  • Fax:
Mailing address:
  • Phone: 216-712-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC0600157
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: