Healthcare Provider Details

I. General information

NPI: 1659445260
Provider Name (Legal Business Name): JANICE GUPTA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MINOR AVNEUE
SEATTLE WA
98104
US

IV. Provider business mailing address

515 MINOR AVNEUE
SEATTLE WA
98104
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-9500
  • Fax: 206-386-9605
Mailing address:
  • Phone: 206-386-9500
  • Fax: 206-386-9605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number233513
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberOP60403797
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: