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General NPI Number Information
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NPI Number | 1396309639
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Entity Type | Organization
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Legal Business Name | AMITA UPADHYAY MD INC.
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 04/23/2019
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Provider Practice Location Address
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Address Line | 508 GIBSON DR STE 270
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City | ROSEVILLE
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State | CA
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Zip | 95678-5795
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Country | US
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Telephone | 916-786-6727
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Fax | 916-786-6748
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Provider Business Mailing Address
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Address Line | 508 GIBSON DR STE 270
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City | ROSEVILLE
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State | CA
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Zip | 95678-5795
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Country | US
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Telephone | 916-786-6727
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Fax | 916-786-6748
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMITA UPADHYAY
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Credential | MD
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Telephone | 916-786-6727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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